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胰体尾癌患者行扩大胰体尾切除术的可行性研究

Viability of extended distal pancreatectomy for pancreatic adenocarcinoma of the body or tail

摘要:

目的 探讨扩大胰体尾切除术治疗胰体尾癌的可行性及其预后影响因素.方法 回顾性分析2011年1月至2014年12月四川大学华西医院收治的57例胰体尾癌患者资料,按照手术方式不同分为标准胰体尾切除组(n=35)和扩大胰体尾切除组(n=22).通过t检验、x2检验等对两种术式的安全性和生存预后进行比较,并对预后相关因素进行Cox回归分析.结果 与标准胰体尾切除组相比,扩大胰体尾切除组的手术时间长[(255±91) min比(208±80) min](t=2.066,P=0.044),输血率升高(50.0%比17.1%)(x2=12.836,P=0.008),但术中出血量和术后住院时间无差异(P值均>0.05).扩大胰体尾切除组胃排空延迟发生率更高(22.7%比2.9%)(Z=-2.251,P =0.027),但两组间并发症发生率、再手术率、病死率无差异(P值均>0.05).标准胰体尾切除组和扩大胰体尾切除组中位生存时间分别为13.1个月和8.2个月,两组生存比较差异无统计学意义(P>0.05).多因素分析结果显示,肿瘤大小(RR=1.275,P=0.03)和围手术期输血(RR=2.673,P=0.04)为独立预后因素.结论 虽然扩大胰体尾切除组患者的病理分期较晚,但经过扩大胰体尾切除,可取得与标准胰体尾切除组患者相当的生存获益.肿瘤大小和围手术期输血是影响胰体尾癌患者预后的独立因素.

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abstracts:

Objective To analyze the viability of extended distal pancreatectomy and the associated prognostic factors.Methods The data of 57 patients with pancreatic adenocarcinoma who underwent standard distal pancreatectomy (DP) or extended distal pancreatectomy (EDP) from January 2011 to December 2014 were reviewed retrospectively.Thirty-five patients were performed with DP and 22 with EDP.Operation safety and survival benefit between DP and EDP were compared by t-test or x2 test.Cox regression analysis was used to explore the prognostic indicators.Results Compared to DP group,operation time((255 ±91)min vs.(208 ±80)min)(t =2.066,P =0.044) and ratio of blood transfusion (50.0% vs.17.1%) (x2 =12.836,P =0.008) were greater in EDP group,respectively.There were no significant differences in amount of intraoperative blood loss and postoperative duration of hospitalization.Delayed gastric emptying was greater in EDP(22.7% vs.2.9%) (Z =-2.251,P =0.027),while other complications had no differences.Mortality and ratio of relaparotomy also showed no differences.Median survival following DP was 13.1 months compared to 8.2 months following EDP.There was no difference in survival between DP and EDP.According to the results of multivariate analysis,tumor size (RR =1.275,P =0.03) and perioperative blood transfusions(RR =2.673,P =0.04) were independent prognostic factors.Conclusions Though patients with pancreatic adenocarcinoma who undergo EDP have a worse pathologic staging,they will gain a comparable long-term survival to the patients undergo DP.Tumor size and perioperative blood transfusions are independent prognostic factors.

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