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目的:研究无接触分离技术(no-touch isolation technique,NTIT)在胰头癌根治性切除术中的应用,探讨以NTIT技术为重点的胰十二指肠切除术对肿瘤转移及预后的影响。方法:对2004年2月～2009年9月施行胰十二指肠切除术的57例胰头癌患者进行对照研究。其中NTIT组32例,常规手术组25例。测定手术病例肿瘤切除前、后门静脉血细胞角蛋白20(CK20)mRNA表达情况。分析两组生存期、肝转移率和死亡率。结果:两组患者术后并发症发生率无明显差异。切除肿瘤病灶前,门静脉血内CK20mRNA的阳性表达率常规手术组和NTIT组分别为16.00%、18.75%,无统计学差异。肿瘤切除后,常规手术组CK20mRNA的阳性率显著高于NTIT组(52.00%vs.25.00%,P=0.036)。术后随访,NTIT组、常规手术组术后1、3、5年生存率分别为76.6%、50.0%、40.0%和75.0%、33.3%、8.8%。NTIT组5年生存率高于常规手术组(P=0.018)。术后死亡原因分析显示NTIT组肝转移率显著低于常规手术组(P=0.024)。结论:胰头癌根治性切除术中采用NTIT技术能有效减少癌细胞播散,减少术后肝转移发生率,改善预后。
Objective: To study the application of no-touch isolation technique (NTIT) in the radical resection of pancreatic head cancer and to explore the influence of pancreaticoduodenectomy on the metastasis and prognosis of pancreatic cancer. METHODS: Fifty-seven patients with pancreatic head cancer who underwent pancreatoduodenectomy from February 2004 to September 2009 were enrolled in this study. NTIT group of 32 cases, 25 cases of conventional surgery group. The expression of cytokeratin 20 (CK20) mRNA in portal vein was measured before and after tumor resection. Survival, liver metastasis and mortality in both groups were analyzed. Results: There was no significant difference in postoperative complications between the two groups. Before tumor resection, the positive rate of CK20mRNA in portal vein was 16.00% and 18.75% respectively in normal operation group and NTIT group, with no significant difference. After tumor resection, the positive rate of CK20 mRNA in routine operation group was significantly higher than that in NTIT group (52.00% vs.25.00%, P = 0.036). The postoperative follow-up showed that the 1, 3, 5-year survival rates of NTIT group and conventional surgery group were 76.6%, 50.0%, 40.0% and 75.0%, 33.3% and 8.8% respectively. The 5-year survival rate was higher in the NTIT group than in the conventional surgery group (P = 0.018). Analysis of postoperative death causes showed that hepatic metastasis rate was significantly lower in the NTIT group than in the conventional surgery group (P = 0.024). Conclusion: NTIT technique can effectively reduce the spread of cancer cells, reduce the incidence of postoperative liver metastases and improve the prognosis.