摘要
目的探讨胰头癌胰十二指肠切除术切缘癌细胞残留(R1)的发生率及其对临床实践的启示。方法 2010年11月～2012年3月我科同一个手术组对28例胰头癌行根治性胰十二指肠切除(标准化组,n=28),标本除常规取胰腺颈部断端、胆总管断端、胃体空肠断端外,还常规标记和切取肠系膜上静脉沟切缘、钩突切缘与胰头后表面切缘,切缘表面有肿瘤细胞残留为R1。回顾分析我科同一个手术组2009年2月～2010年11月38例胰头癌行根治性胰十二指肠切除(非标准化组,n=38),比较2组R1发生率。结果标准化组R1发生率53.6%(15/28)显著高于非标准化组13.2%(5/38,χ2=12.467,P=0.000)。标准化组肠系膜上静脉沟切缘(9/15,60.0%)和钩突切缘(8/15,53.3%)是最常受累及的切缘,33.3%(5/15)的患者同时累及2个切缘。结论对胰十二指肠切除标本进行标准化取材能够显著提高R1的发生率,提供准确的病理信息。术中应该尽可能根治性切除钩突部,必要时联合切除肠系膜上静脉,以降低R1的发生率。
Objective To investigate the R1 rate of pancreaticoduodenectomy in patients with pancreatic head cancer, and to discuss its significance in clinical practice. Methods From November 2011 to March 2012, a single team in our hospital performed radical pancreaticoduodenectomy on 28 patients with pancreatic head cancer by using standardized pathological protocol （SP group）. Specimens were collected from the resection margin of the pancreatic neck, common bile duct, stomach/jejunum, as well as the circumferential soft margins （the SMV groove, nucinate process margin and posterior surface）. R1 margin was defined as the margins with tumor ceils presented at the surface. A group of patients, who received radical pancreaticoduodenectomy without using standardized pathological protocol from February 2009 to November 2010 for pancreatic head cancer by a same team, were set as a control group. The R1 rate was compared between the groups. Results The R1 rate was 53.6% （15/28） in the SP group, which was significantly higher than the control （13.2%, 5/38, X2 = 12. 467, P = 0. 000）. The SMV groove and uncinate process margins were the most affected margins （9/15, 60.0% and 8/15, 53. 3%）, in 33.3% of the patients （5/15）, both the margins were involved. Conclusions Standardized technique for obtaining pancreatoduodcnectomy specimens can significantly rise the R1 rate on the resection margin, so that to provide accurate pathological information. The uncinate process and SMV groove should be resected radically to decrease R1 rate. The SMV shall be resected when necessary.
出处
《中国微创外科杂志》
CSCD
2012年第7期608-611,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
胰头癌
胰十二指肠切除
切缘
Pancreatic head cancer
Pancreatoduodenectomy
Margin
