Abstract:

Objective　To investigate the effect of extended lymph node dissection pancreaticoduodenectomy  (PD) for patients with pancreatic adenocarcinoma. Methods　Seventy-eight patients with pancreatic adenocarcinoma treated in Nanyang Second People's Hospital from January 2020 to December 2023 were selected for the randomized controlled trial, and were divided into an extended dissection group and a standard dissection group by the random number table method, with 39 cases in each group. There were 22 males and 17 females in the expanded dissection group; they were (59.85±3.26) years old; their body mass index was (22.71±1.08) kg/m²; the maximum tumor diameter was (3.38±1.01) cm. There were 24 males and 15 females in the standard dissection group; they were (60.05±3.34) years old; their body mass index was (22.78±1.12) kg/m²; the maximum tumor diameter was (3.40±0.97) cm. Both groups were treated with PD; the standard dissection group took standard lymph node dissection, and the extended dissection group extended lymph node dissection. The intraoperative indicators (operation time, intraoperative bleeding volume, intraoperative blood transfusion volume, total number of lymph node dissection, and number of positive lymph node dissection), postoperative recovery indicators (time to get out of bed, time for first liquid diet, time to drainage tube extraction, and hospital stay), incidence rates of complications, lymph node metastasis rates, in situ recurrence rates, and survival rates were compared between the two groups. χ² and t tests were used for the statistical analysis. Results　The operation time, intraoperative bleeding volume, intraoperative blood transfusion volume, total number of lymph node dissection, and number of positive lymph node dissection in the extended dissection group were (401.36±38.90) min, (293.66±31.68) ml, (145.89±22.17) ml, 24.41±4.33, and 13.69±2.12; those in the standard dissection group were (376.52±33.22) min, (276.85±29.41) ml, (133.34±20.64) ml, 16.98±3.86, and 11.12±2.05; there were statistical differences (all P<0.05). There were no statistical differences in the time to get out of bed, time for first liquid diet, time to drainage tube extraction, hospital stay, total incidence rate of complications, lymph node metastasis rate, in situ recurrence rate, and survival rate between the two groups (all P>0.05). Conclusion　Extended lymph node dissection PD for patients with pancreatic adenocarcinoma can increase the total number of lymph node dissection and the number of positive lymph node dissection, but will increase the surgical trauma and prolong the surgical time, and can not improve the survival rate.

Key words:

Pancreatic adenocarcinoma, Extended lymph node dissection, Pancreaticoduodenectomy, Perioperative indicators, Complications,  , Prognosis

摘要：

目的　探讨扩大淋巴结清扫胰十二指肠切除手术（pancreatoduodenectomy，PD）治疗胰腺癌患者的效果。方法　选取2020年1月至2023年12月南阳市第二人民医院收治的78例胰腺癌患者进行随机对照试验。采用随机数字表法将其分为扩大清扫组与标准清扫组，各39例。扩大清扫组男22例，女17例，年龄（59.85±3.26）岁，体重指数（22.71±1.08）kg/m²，肿瘤长径（3.38±1.01）cm。标准清扫组男24例，女15例，年龄（60.05±3.34）岁，体重指数（22.78±1.12）kg/m²，肿瘤长径（3.40±0.97）cm。两组均行PD治疗，标准清扫组标准清扫淋巴结，扩大清扫组扩大清扫淋巴结。比较两组术中指标（手术时间、术中出血量、术中输血量、淋巴结清扫总数、阳性淋巴结清扫个数）、术后恢复指标（下床时间、首次流质饮食时间、引流管拔出时间、住院时间）、并发症发生率、淋巴结转移率、原位复发率及生存率。采用χ²检验与t检验进行统计分析。结果　扩大清扫组手术时间、术中出血量、术中输血量、淋巴结清扫总数、阳性淋巴结清扫个数分别为（401.36±38.90）min、（293.66±31.68）ml、（145.89±22.17）ml、（24.41±4.33）枚、（13.69±2.12）枚，标准清扫组分别为（376.52±33.22）min、（276.85±29.41）ml、（133.34±20.64）ml、（16.98±3.86）枚、（11.12±2.05）枚，差异均有统计学意义（均P<0.05）。两组下床时间、首次流质饮食时间、引流管拔出时间、住院时间、并发症总发生率、淋巴结转移率、原位复发率及生存率比较，差异均无统计学意义（均P>0.05）。结论　扩大淋巴结清扫PD治疗胰腺癌患者可提高淋巴结清扫总数及阳性淋巴结清扫个数，但扩大淋巴结清扫会增加手术创伤，延长手术时间，并不能提高患者生存率。

关键词:

胰腺癌, 扩大淋巴结清扫, 胰十二指肠切除手术, 围手术期指标, 并发症, 预后