李更天 1胡智明 2赵大建 2邵钦树 2邹寿椿 2张成武2
作者信息
- 1. 浙江省东阳市中医院外科,浙江金华322100
- 2. 浙江省人民医院肝胆外科,浙江杭州310014
- 折叠
摘要
Abstract
Objective To explore and discuss the clinical significance of standardized regional lymph node dissection in pancreatic head cancer pancreatoduodenectomy. Methods Forty-eight cases of pancreatic head cancer with standardized regional lymph node dissection based on the conventional whipple from January 2008 to October 2010 in our department were retrospectively analyzed. The standardized regional lymph node dis-section was performed using the JPS lymph node group standard (5th edition, 2002), which includes all lymph nodes around the hepatic artery (8a, 8p), the celiac trunk (9) and the hepatoduodenal ligament (12habpc), all lymph nodes behind pancreas and duodenum (13a, 13b), lymph nodes near the right side of SMA from the start part of SMA to inferior pancreaticoduodenal artery (IPDA) (14abcd), lymph nodes in front of pancreas (17a, 17b), lymph nodes in front of the abdominal aorta and inferior vena cava from celiac artery to superior mesenteric artery (IMA) as well as the Gerota fascia. Results The entire 48 patients received whipple D2 radical surgery included standardized regional lymph node dissection, and all of the cases were performed the pancreatic and biliary-section examination that confirmed no positive during the surgery. One of the patients received the partial resection and reconstruction of the superior mesenteric vein because of the tumor invading. After the surgery, 2 cases complicated with a small amount of pancreatic fistula, 2 cases of gastric paralysis, 3 cases of wound infection, 1 case of acute left ventricular failure, and 1 died from multiple organ failure. The pathological report showed there were lymph node metastasis in 20 cases (41.6%) among 48 patients, in which, back of pancreas and duodenum (13a, 13b), lymph nodes around the start part of SMA (14abcd) were the highest incidence places (8/48, 16.7%). Of all the cases, Nl lymph nodes metastasis were found in 4 people (8/20, 40.0%), N2 lymph nodes metastasis in 3 people (6/20, 30.0%), N3 lymph nodes metastasis in 3 people (6/20, 30.0%). Conclusion Standardized regional lymph node dissection can effectively rid up more lymph nodes and retroperitoneum tissue, without increasing its mortality and complications of the surgery.关键词
胰腺肿瘤/胰头十二指肠切除术/淋巴结切除术Key words
pancreatic neoplasms/ pancreatoduodenectomy/ lymph node excision分类
医药卫生
