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目的探讨胰头癌胰十二指肠切除术切缘癌细胞残留(R1)的发生率及其对临床实践的启示。方法 2010年11月～2012年3月我科同一个手术组对28例胰头癌行根治性胰十二指肠切除(标准化组,n=28),标本除常规取胰腺颈部断端、胆总管断端、胃体空肠断端外,还常规标记和切取肠系膜上静脉沟切缘、钩突切缘与胰头后表面切缘,切缘表面有肿瘤细胞残留为R1。回顾分析我科同一个手术组2009年2月～2010年11月38例胰头癌行根治性胰十二指肠切除(非标准化组,n=38),比较2组R1发生率。结果标准化组R1发生率53.6%(15/28)显著高于非标准化组13.2%(5/38,χ2=12.467,P=0.000)。标准化组肠系膜上静脉沟切缘(9/15,60.0%)和钩突切缘(8/15,53.3%)是最常受累及的切缘,33.3%(5/15)的患者同时累及2个切缘。结论对胰十二指肠切除标本进行标准化取材能够显著提高R1的发生率,提供准确的病理信息。术中应该尽可能根治性切除钩突部,必要时联合切除肠系膜上静脉,以降低R1的发生率。
Objective To investigate the incidence of residual cancer (R1) in pancreatic cancer of pancreaticoduodenectomy and its implications for clinical practice. Methods From November 2010 to March 2012, 28 patients with pancreatic head carcinoma were treated with radical pancreatoduodenectomy (standardization group, n = 28) in the same operation group. The specimens were removed from the neck of the pancreas, Common bile duct ends, stomach jejunum stump ends, but also conventional marking and excision of the superior mesenteric vein groove edge, the edge of the uncinate process and the incision of the posterior surface of the head, the edge of the tumor cell residual surface R1. Retrospective analysis of the same surgery group in our department from February 2009 to November 2010 38 cases of pancreatic cancer of the pancreas radical pancreatoduodenectomy (non-standardized group, n = 38), the incidence of R1 in two groups were compared. Results The prevalence of R1 was 53.6% (15/28) in the standardization group and 13.2% (5/38) in the standardization group (χ2 = 12.467, P = 0.000). The normalized mesenteric vein groove margin (9/15, 60.0%) and the uncinate process margin (8/15, 53.3%) were the most commonly affected margins, with 33.3% (5/15) of the patients involving 2 Cut edge. Conclusions The standardization of pancreaticoduodenectomy specimens can significantly increase the incidence of R1 and provide accurate pathological information. Intraoperative resection of the hysterectomy should be as radical as possible, combined with the removal of the superior mesenteric vein, in order to reduce the incidence of R1.