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目的探讨胰腺癌后腹膜整块切除扩大清扫术(PERC)的安全性和有效性。方法回顾性分析2014年1月至2015年7月南京医科大学第一附属医院胰腺中心收治的行PERC的28例胰腺癌病人的临床资料。术前影像学评估为可切除或可能切除,术中行联合淋巴组织、脂肪组织、纤维结缔组织及神经组织的后腹膜整块切除扩大清扫,仅保留必要的动静脉。结果所有28例病人均顺利完成手术,无死亡病例;手术时间为340(150~540)min;术中失血量为400(200~700)m L。术后并发症发生率为42.9%(12/28)。病人术后住院时间为13(8~30)d。清扫淋巴结数为12(5~36)枚。19例病人达到R0切除,9例病人为R1切除。随访12(3~27)个月,4例病人出现局部复发,11例病人出现远处转移;15例病人死亡,其中因肿瘤进展死亡9例,另外6例病人未发现复发和远处转移而死亡;13例存活病人中,6例病人截至末次随访,未发现局部复发和远处转移,目前最长无瘤生存时间为27个月。结论 PERC治疗胰腺癌安全、可行,不增加手术并发症,可提高胰腺癌R0切除率,可望通过减少术后局部复发以改善病人预后。
Objective To investigate the safety and efficacy of retroperitoneal dissection and extended dissection (PERC) after pancreatic cancer. Methods The clinical data of 28 patients with pancreatic cancer who underwent PERC in the Pancreatic Center of the First Affiliated Hospital of Nanjing Medical University from January 2014 to July 2015 were retrospectively analyzed. Preoperative imaging assessment of resectable or possible resection, intraoperative combined lymphoid tissue, adipose tissue, fibrous connective tissue and nerve tissue of the retroperitoneal lump resection to expand the clean, leaving only the necessary arteriovenous. Results All the 28 patients completed the operation without any deaths. The operation time was 340 (150-540) min. The intraoperative blood loss was 400 (200-700) m L. The incidence of postoperative complications was 42.9% (12/28). The patient’s postoperative hospital stay was 13 (8-30 days). Sweeping lymph nodes for the 12 (5 ~ 36) pieces. Nineteen patients achieved R0 resection and nine patients were resected for R1. During the follow-up of 12 (3-27) months, 4 patients had local recurrence and 11 patients had distant metastasis. Fifteen patients died, of which 9 died of tumor progression and 6 patients did not find recurrence and distant metastasis Died. Among the 13 survivors, 6 patients had no local recurrence and distant metastases up to the last follow-up. The longest tumor-free survival time was 27 months. Conclusions PERC is safe and feasible for the treatment of pancreatic cancer. It can improve the R0 resection rate of pancreatic cancer without increasing the complication of surgery, and it is expected to improve the prognosis of patients by reducing the local recurrence after operation.