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目的:探讨胰头癌患者肠系膜上动脉(SMA)周围淋巴结(第14组淋巴结)清扫与淋巴结细胞角蛋白(CK)检测的临床价值。方法:分析24例单纯行胰十二指肠切除术(PD)胰头癌患者(PD组)与32例行PD+SMA周围淋巴结清扫术胰头癌患者(PD+SMA清扫组)的临床资料,比较两组围手术期情况与术后生存率;比较常规病理学检测与CK免疫组化检测对淋巴结微转移的检出率。结果:PD组与PD+SMA组比较,术中出血量[(1 462.5±911.73)mL vs.(1 687.5±1 522.63)mL],手术时间[(4.5±1.03)h vs.(5.0±1.25)h],术后住院时间[(16.13±3.09)d vs.(18.25±7.17)d]及术后并发症发生率(8.3%vs.9.4%)的差异均无统计学意义(均P>0.05);PD+SMA清扫组术后3年生存率明显高于PD组(P=0.044);PD+SMA清扫组切除的淋巴结常规病理检测阳性率为6.25%(2/32),经CK检测增加至21.88%(7/32)。结论:胰头癌患者SMA周围淋巴结中肿瘤细胞微转移发生率较高,CK检测能提高淋巴结微转移的检出率。PD加行SMA的骨骼化清扫并不增加手术风险及术后并发症发生率,且能改善胰头癌患者预后。
Objective: To investigate the clinical value of clearance of lymph nodes (group 14) and cytokeratin (CK) in patients with pancreatic head cancer. Methods: Twenty-four patients (PD group) with pancreaticoduodenectomy (PD) and 32 patients (PD + SMA group) with PD + SMA peritumoral lymph node dissection The perioperative and postoperative survival rates were compared between the two groups. The detection rate of lymph node micrometastasis by routine pathological examination and CK immunohistochemistry was compared. Results: Compared with the PD + SMA group, the intraoperative blood loss [(1462.5 ± 911.73) mL vs. (1887.5 ± 1 522.63) mL], operative time [(4.5 ± 1.03) h vs. (5.0 ± 1.25 ) h], postoperative hospital stay [(16.13 ± 3.09) d vs. (18.25 ± 7.17) d] and postoperative complication rate (8.3% vs 9.4%) had no significant difference (all P> 0.05). The 3-year survival rate of PD + SMA group was significantly higher than that of PD group (P = 0.044). The positive rate of routine pathological examination of lymph node dissection in PD + SMA group was 6.25% (2/32) Increase to 21.88% (7/32). Conclusion: The incidence of micrometastases in peripheral lymph nodes of patients with pancreatic head cancer is high, and the detection of CK can improve the detection rate of lymph node micrometastasis. Skeletal dissection of PD plus SMA does not increase the risk of surgery and the incidence of postoperative complications, and can improve the prognosis of patients with pancreatic head cancer.