探讨扩大淋巴结清扫在交界可切除胰头癌术中的应用价值。

回顾性分析2015年1月至2020年12月首都医科大学附属北京朝阳医院收治的94例交界可切除胰头癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男41例，女53例；年龄29~78岁，中位年龄62岁。根据手术方式将患者分为扩大淋巴结清扫组（扩大清扫组，50例）和标准淋巴结清扫组（标准清扫组，44例）。观察两组患者围手术期和生存情况。两组淋巴结清扫数比较采用秩和检验，并发症发生率、死亡率比较采用χ²检验或Fisher确切概率法，生存分析采用Kaplan-Meier法和Log-rank检验。

本组94例患者均顺利完成手术。扩大清扫组术后总并发症发生率为34%（17/50），标准清扫组为30%（13/44），差异无统计学意义（χ²=0.214，P>0.05）；两组围手术期死亡分别为0、2例，差异无统计学意义（P=0.419）。扩大清扫组淋巴结清扫数为25（15）个，明显大于标准清扫组的18（15）个（Z=2.243，P<0.05）。扩大清扫组术后腹泻发生率30%（15/50），明显高于标准清扫组的7%（3/44） （χ²=8.124，P<0.05）。扩大清扫组和标准清扫组术后1、2、3年无瘤生存率分别为54.1%、44.4%、27.3%和34.9%、19.0%、19.0%，差异有统计学意义（χ²=5.571，P<0.05）。扩大清扫组和标准清扫组术后1、2、3年总体生存率分别为66.1%、49.9%、29.7%和48.8%、16.7%、16.7%，差异有统计学意义（χ²=8.350，P<0.05）。

扩大淋巴结清扫术有助于改善交界可切除胰头癌患者远期预后，且不增加围手术期总并发症发生率和死亡率，但术后腹泻发生率升高。

To evaluate the application value of extended lymph node dissection in surgical resection of borderline resectable pancreatic head cancer.

Clinical data of 94 patients with borderline resectable pancreatic head cancer admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2015 to December 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 41 patients were male and 53 female, aged from 29 to 78 years, with a median age of 62 years. All patients were divided into the extended lymph node dissection group (extended dissection group, n=50) and standard lymph node dissection group (standard dissection group, n=44). The perioperative conditions and survival of patients in two groups were observed. The number of resected lymph nodes between two groups were compared by rank-sum test. The incidence of complications and mortality between two groups were statistically compared by Chi-square test or Fisher's exact test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

The surgery of all 94 patients were completed successfully. The total incidence of postoperative complications in the extended dissection group was 34%(17/50) and 30%(13/44) in the standard dissection group, where no significant difference was observed (χ²=0.214, P>0.05). No death case was noted in the extended dissection group, and 2 cases died in the standard dissection group, where no significant difference was observed (P=0.419). The number of resected lymph nodes in the extended dissection group was 25(15), significantly higher than 18(15) in the standard dissection group (Z=2.243, P<0.05). The incidence of postoperative diarrhea in the extended dissection group was 30%(15/50), which was significantly higher than 7%(3/44) in the standard dissection group (χ²=8.124, P<0.05). The 1-, 2-, 3-year disease-free survival rates in the extended group were 54.1%, 44.4%, 27.3%, and 34.9%, 19.0%, 19.0% in the standard dissection group, respectively, significant difference was noted between two groups (χ²=5.571, P<0.05). The 1-, 2-, 3-year overall survival rates in the extended group were 66.1%, 49.9%, 29.7%, and 48.8%, 16.7%, 16.7% in the standard dissection group, respectively, significant difference was noted between two groups (χ²=8.350, P<0.05).

Extended lymph node dissection contributes to improving the long-term prognosis of patients with borderline resectable pancreatic head cancer, which does not increase the total incidence of perioperative complications or mortality, but the incidence of postoperative diarrhea may increased.