肠系膜上动脉全周清扫在胰腺癌根治术中的应用研究

Application of superior mesenteric artery sweeping in radical surgery of pancreatic cancer

摘要:

目的 观察肠系膜上动脉全周清扫在胰腺癌根治术中的应用效果。方法 该研究为前瞻性研究，选择河南大学第一附属医院2021年5月至2022年10月收治的90例胰腺癌患者为研究对象，以计算机随机分组法将其列为常规组和试验组，各45例。两组均实施胰腺癌根治术治疗，常规组术中实施常规淋巴清扫，试验组术中实施肠系膜上动脉全周淋巴清扫，所有患者术后开展为期1年随访，比较两组患者的围手术期临床指标、近期疗效及短期预后。结果 在不同淋巴清扫范围下，试验组的手术时间、术中淋巴清扫数分别为（335.25±20.61）min、（11.42±3.31）枚，均高于常规组［（320.33±20.41）min、（9.25±1.36）枚］（P<0.05）；试验组的术中出血量、术中输血率、术后恢复排气时间、恢复进食时间、住院时间分别为（350.25±20.77）mL、17.78%（8/45）、（6.25±1.28）h、（7.41±1.36）h、（10.25±2.36）d，略高于常规组［（345.66±20.77）mL、13.33%（6/45）、（5.82±1.36）h、（6.93±1.49）h、（9.85±1.27）d］（P>0.05）。试验组癌胚抗原（CEA）、糖类抗原199（CA199）、糖类抗原242（CA242）分别为（260.35±20.41）ng/mL、（240.33±20.35）U/mL、（345.26±20.55）IU/mL，略低于常规组［（262.35±20.72）ng/mL、（243.11±20.36）U/mL、（347.35±20.66）IU/mL］（P>0.05）；试验组的客观缓解率（ORR）、疾病控制率（DCR）分别为84.44%（38/45）、88.89%（40/45），略高于常规组［80.00%（36/45）、82.22%（37/45）］（P>0.05）。试验组一年内无进展生存（PFS）率、总生存（OS）率、中位PFS、中位OS分别为71.11%（32/45）、77.78%（35/45）、（9.29±1.33）个月、（10.41±2.23）个月，均高于常规组［55.56%（25/45）、62.22%（28/45）、（8.33±1.25）个月、（9.21±1.47）个月］（P<0.05）；试验组一年内病情复发率8.89%（4/45）低于常规组26.67%（12/45）（P<0.05）。试验组的并发症发生率13.33%（6/45）略高于常规组11.11%（5/45）（P>0.05）。结论 肠系膜上动脉全周清扫可扩大胰腺癌根治术患者的淋巴清扫范围，并增加淋巴清扫数，可在不影响近期疗效且不增加手术风险同时，有效降低病情复发风险并提高生存率、延长生存周期。

Abstract:

Objective To observe the effect of superior mesenteric artery (SMA) sweeping in the radical operation of pancreatic cancer.Methods This study is a prospective study. Ninety patients with pancreatic cancer who were admitted from May 2021 to October 2022 were selected as the subjects. They were randomly divided into the routine group (45 cases) and the experimental group (45 cases) by computer. Both groups were treated with radical surgery for pancreatic cancer. Routine lymph node dissection was performed in the routine group, and the experimental group was performed with peripheral lymph node dissection of the superior mesenteric artery during the operation. All patients were followed up for one year after the operation. The perioperative clinical indicators, short-term efficacy, and short-term prognosis between two groups of patients were compared.Results Under different lymph node dissection ranges, the surgical time and intraoperative lymph node dissection number in the experimental group were 335.25±20.61 minutes and 11.42±3.31 pieces, higher than the conventional group (320.33±20.41 minutes and 9.25±1.36 pieces) (P<0.05). The intraoperative bleeding volume, intraoperative blood transfusion rate, postoperative recovery time for exhaust, recovery time for eating, and hospital stay in the experimental group were [350.25±20.77 mL, 17.78% (8/45), 6.25±1.28 h, 7.41±1.36 h, and 10.25±2.36 d], slightly higher than the conventional group [345.66±20.77 mL, 13.33% (6/45), 5.82±1.36 h, 6.93±1.49 h, and 9.85±1.27 d] (P>0.05). The CEA, CA199, and CA242 of the experimental group were 260.35±20.41 ng/mL, 240.33±20.35 U/mL, and 345.26±20.55 IU/mL, slightly lower than the conventional group (262.35±20.72 ng/mL, 243.11±20.36 U/mL, and 347.35±20.66 IU/mL). The ORR and DCR of the experimental group were 84.44% (38/45) and 88.89% (40/45), slightly higher than the conventional group [80.00% (36/45) and 82.22% (37/45)] (P>0.05). The PFS rate, OS rate, median PFS, and median OS of the experimental group within one year were 71.11% (32/45), 77.78% (35/45), 9.29±1.33 months, and 10.41±2.23 months, higher than the conventional group [55.56% (25/45), 62.22% (28/45), 8.33±1.25 months, and 9.21±1.47 months]. The recurrence rate of the disease within one year was 8.89% (4/45), lower than the conventional group's 26.67% (12/45) (P<0.05). The incidence of complications in the experimental group was 13.33% (6/45), slightly higher than 11.11% (5/45) of the conventional group (P>0.05).Conclusion Peripheral dissection of superior mesenteric artery can expand the scope of lymph node dissection and increase the number of lymph nodes dissection in patients with pancreatic cancer undergoing radical surgery. It can effectively reduce the risk of disease recurrence, improve the survival rate and prolong the life cycle without affecting the short-term efficacy and increasing the risk of surgery.