切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 251 -254. doi: 10.3877/cma.j.issn.1674-3946.2024.03.006

论著

新辅助化疗后LPD钩突切除中先动脉后静脉原则的安全性研究
孟宇1, 李金超1, 刘金来1, 刘晨1, 王振勇1,()   
  1. 1. 061001 河北沧州,沧州市中心医院肝胆胰外一科
  • 收稿日期:2023-09-21 出版日期:2024-06-26
  • 通信作者: 王振勇

Safety study of the principle of anterior artery and posterior vein in uncinate process resection of LPD after neoadjuvant chemotherapy

Yu Meng1, Jinchao Li1, Jinlai Liu1, Chen Liu1, Zhenyong Wang1,()   

  1. 1. First Department of Hepatobiliary, Pancreatic, Cangzhou Central Hospital, Cangzhou Hebei Province 061001, China
  • Received:2023-09-21 Published:2024-06-26
  • Corresponding author: Zhenyong Wang
  • Supported by:
    Cangzhou City Key R & D Plan Guidance Project Project(204106116)
引用本文:

孟宇, 李金超, 刘金来, 刘晨, 王振勇. 新辅助化疗后LPD钩突切除中先动脉后静脉原则的安全性研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 251-254.

Yu Meng, Jinchao Li, Jinlai Liu, Chen Liu, Zhenyong Wang. Safety study of the principle of anterior artery and posterior vein in uncinate process resection of LPD after neoadjuvant chemotherapy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(03): 251-254.

目的

探讨新辅助化疗(NAC)后腹腔镜胰十二指肠切除术(LPD)钩突切除中先动脉后静脉原则的安全性。

方法

回顾性分析2018年6月至2023年6月完成NAC后行LPD的136例胰腺癌患者的临床资料,根据钩突切除中入路原则的不同分为研究组(n=74例,采用先动脉后静脉原则)和对照组(n=62例,采用先静脉后动脉的原则)。数据应用软件SPSS 22.0处理。围手术期指标等计量资料采用()表示,行独立样本t检验;术后并发症等计数资料采用[例(%)]表示,行秩和检验或χ2检验;生存分析采用Kaplan-Meier法并行Log-Rank检验。P<0.05表示差异有统计学意义。

结果

研究组患者手术时间、钩突离断时间及术中出血量较对照组均显著降低,淋巴结清扫数目及R0切除率显著升高,差异均有统计学意义(P<0.05);两组患者引流管拔除时间及术后住院时间比较,差异均无统计学意义(P >0.05)。研究组患者术后并发症的总发生率低于对照组(17.6% vs. 27.4%),但差异无统计学意义(P>0.05)。研究组患者的累积无病生存率(77.0% vs. 67.7%)和累积总生存率(79.7% vs. 71.0%)均显著高于对照组,差异有统计学意义(P<0.05)。

结论

NAC后LPD钩突切除中先动脉后静脉原则是安全、有效的,此原则在不增加术后并发症的同时,不仅可有效缩短手术时间、减少术中损伤、提高淋巴结清扫的彻底性和R0切除率,还可提高患者的生存率。

Objective

To investigate the safety of the anterior artery and posterior vein principle in laparoscopic pancreaticoduodenectomy (LPD) of uncinate process after neoadjuvant chemotherapy (NAC).

Methods

The clinical data of 136 patients with pancreatic cancer who underwent LPD after completing NAC from June 2018 to June 2023 were retrospectively analyzed, and were divided into study group (n=74 cases, using the principle of prevenous and then venous) and control group (n=62 cases, using the principle of prevenous and then arterial) according to different approach principles during uncinate process resection. The data was processed by SPSS 22.0. Measurement data such as perioperative indexes were represented by (), and independent sample t test was performed. The statistical data of postoperative complications were represented by [cases (%)], Rank Sum test or χ2 test. Kaplan-Meier method and Log-Rank test were used for survival analysis. P<0.05 indicated that the difference was statistically significant.

Results

The operative time, uncinate process separation time and intraoperative blood loss in the study group were significantly lower than those in the control group, and the number of lymph node dissection and R0 resection rate were significantly increased in the study group, with statistical significance (P<0.05). There was no significant difference in drainage tube removal time and postoperative hospitalization time between the two groups (P >0.05). The total incidence of postoperative complications in the study group was lower than that in the control group (17.6% vs. 27.4%), but the difference was not statistically significant (P>0.05). The cumulative disease-free survival rate (77.0% vs. 67.7%) and the cumulative overall survival rate (79.7% vs. 71.0%) in the study group were significantly higher than those in the control group, with statistical significance (P<0.05).

Conclusion

The principle of anterior artery and posterior vein resection of uncinate process after NAC is safe and effective. This principle can not only effectively shorten the operation time, reduce intraoperative injury, improve the thoroughness of lymph node dissection and R0 removal rate, but also improve the survival rate of patients without increasing postoperative complications.

表1 两组患者一般资料对比
表2 两组患者围手术期相关指标比较
表3 两组患者术后并发症比较[例(%)]
图1 两组患者术后生存情况比较
[1]
Siegel RLMiller KDFuchs HE,et al. Cancer Statistics,2021[J]. CA Cancer J Clin202171(1): 7-33.
[2]
赵玉沛,邱江东. 中国腹腔镜胰腺癌根治术:20年回顾与展望[J/CD]. 中华普外科手术学杂志(电子版)202115(03): 237-240.
[3]
Versteijne Evan Dam JLSuker M,et al. Neoadjuvant Chemoradiotherapy Versus Upfront Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Long-Term Results of the Dutch Randomized PREOPANC Trial[J]. J Clin Oncol202240(11): 1220-1230.
[4]
牟一平,金巍巍. 腹腔镜胰十二指肠切除术:难点与对策[J]. 中国实用外科杂志202242(05): 491-493.
[5]
梁贇,王巍. 腹腔镜胰十二指肠切除术手术入路的选择[J]. 中国普外基础与临床杂志202128(09): 1125-1128.
[6]
Mazzola MGiani ABertoglio CL,et al. Standardized right artery first approach during laparoscopic pancreaticoduodenectomy for periampullary neoplasms: technical aspects and perioperative outcomes[J]. Surg Endosc202337(1): 759-765.
[7]
逯雨轩,崔云甫. 应用动脉优先入路行胰十二指肠切除术治疗胰腺癌研究现状[J]. 腹部外科202134(01): 22-25.
[8]
鲁天麒,孙备. 2021.V2 NCCN临床实践指南: 胰腺癌更新解读[J]. 临床外科杂志202230(01): 7-9.
[9]
中国抗癌协会胰腺癌专业委员会. 中国胰腺癌综合诊治指南(2020版)[J]. 中华外科杂志202159(02): 81-100.
[10]
白雪莉,陈伟,梁廷波. 中国腹腔镜胰十二指肠切除术20年胰肠重建术式变迁与未来发展[J/CD]. 中华普外科手术学杂志(电子版)202115(03): 250-254.
[11]
Chiorean EGChiaro MDTempero MA,et al. Ampullary Adenocarcinoma,Version 1.2023,NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw202321(7): 753-782.
[12]
谭志健,沈展涛,陈桂豪,等. 腹腔镜胰十二指肠切除术中钩突处理技巧[J]. 中国实用外科杂志202242(05): 535-538.
[13]
Choi SHChong EHJang JY. Self-traction Method for Uncinate Process Dissection During Laparoscopic Pancreaticoduodenectomy[J]. J Gastrointest Surg202226(7): 1547-1549.
[14]
Lin RLin XLu F,et al. Combination of anterior superior mesenteric vein-first and right posterior superior mesenteric artery-first approaches for uncinate process dissection in minimally invasive pancreaticoduodenectomy[J]. Gland Surg20209(5):1396-1405.
[15]
Machado MAArdengh JCMakdissi FF,et al. Minimally Invasive Resection of the Uncinate Process of the Pancreas: Anatomical Considerations and Surgical Technique[J]. Surg Innov202229(5): 600-607.
[16]
吴迪,詹志林,周世文,等. 动脉优先入路技术在高难度胰十二指肠切除术中的应用[J]. 中国医刊202257(08): 856-859.
[17]
王树鹏,刘松阳,张威,等. "后入路、钩突先行、动脉优先"在腹腔镜胰十二指肠切除术中的价值分析[J]. 中华医学杂志2020100(42): 3328-3331.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[10] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[11] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[12] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
阅读次数
全文


摘要