血管外膜下剥离技术在累及动脉的胰腺癌切除术中的应用：一项回顾性队列研究。
Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study.
机构信息
Pancreas Centre, The First Affiliated Hospital Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, People's Republic of China.
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
出版信息
Langenbecks Arch Surg. 2021 May;406(3):691-701. doi: 10.1007/s00423-021-02080-5. Epub 2021 Jan 28.
PURPOSE
To introduce sub-adventitial divestment technique (SDT), a procedure to remove the tumor while preserving the artery during curative pancreatectomy. Peri-operative safety profile was also evaluated.
METHODS
In a single center consecutive series of pancreatectomy for pancreatic cancer, the outcome of patients who had pancreatectomy with SDT was compared to standard pancreatic surgery.
RESULTS
From June 2014 to June 2016, 72 patients had pancreatectomy with SDT and 235 had standard surgery. Tumor stage was T4 in all 72 (100%) tumors removed using SDT compared to four (2%) with standard pancreatectomy (p < 0.001). All 72 (100%) tumors in the SDT group were stage III compared to 24 (10%) in the standard surgery group (p < 0.001). Both groups had a high proportion of poorly differentiated tumors (52 (72%) and 163 (69%) respectively) and perineural tumor invasion (62 (86%) and 186 (79%) respectively). R1 (< 1 mm) was found in 24 (86%) of 28 tumors in the SDT group, and in 72 (60%) out of 120 standard pancreatectomy tumors (p = 0.01). Complications occurred in 29 (40%) of the SDT group and in 88 (37%) of the standard group. The in-hospital mortality was four (6%) in the SDT group and one (0.4%) in the standard group (p = 0.01), with a 90-day mortality of 5 (8%)/60 and 6 (3%)/209 (p = 0.07) respectively.
CONCLUSIONS
The sub-adventitial divestment technique appeared to be an effective surgical technique to remove the tumor while preserving the artery. This approach warrants further validation in prospective studies.
目的
介绍亚外膜剥离技术（SDT），一种在根治性胰腺切除术中切除肿瘤同时保留动脉的手术方法。同时评估其围手术期安全性。
方法
在一项连续的单中心胰腺切除术系列研究中，将 SDT 组与标准胰腺手术组的患者手术结果进行比较。
结果
2014 年 6 月至 2016 年 6 月，72 例患者接受了 SDT 胰腺切除术，235 例患者接受了标准手术。使用 SDT 切除的所有 72 例（100%）肿瘤均为 T4 期，而标准胰腺切除术组仅 4 例（2%）为 T4 期（p < 0.001）。SDT 组所有 72 例（100%）肿瘤均为 III 期，而标准手术组为 24 例（10%）（p < 0.001）。两组均有较高比例的低分化肿瘤（分别为 52 例[72%]和 163 例[69%]）和神经周围肿瘤侵犯（分别为 62 例[86%]和 186 例[79%]）。SDT 组 28 例肿瘤中有 24 例（86%）为 R1（< 1mm），标准胰腺切除术组 120 例中有 72 例（60%）为 R1（p = 0.01）。SDT 组发生并发症 29 例（40%），标准手术组发生并发症 88 例（37%）。SDT 组住院死亡率为 4 例（6%），标准手术组为 1 例（0.4%）（p = 0.01），90 天死亡率分别为 5 例（8%）/60 例和 6 例（3%）/209 例（p = 0.07）。
结论
亚外膜剥离技术似乎是一种有效的手术方法，可以在保留动脉的同时切除肿瘤。这一方法值得在前瞻性研究中进一步验证。
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