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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (06) : 608 -612. doi: 10.3877/cma.j.issn.2095-3232.2023.06.004

临床研究

淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响
潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强†()   
  1. 100020　首都医科大学附属北京朝阳医院肝胆胰脾外科
  • 收稿日期:2023-07-27 出版日期:2023-12-10
  • 通信作者: 贺强

Effect of number of dissected lymph nodes on efficacy of pancreaticoduodenectomy for distal cholangiocarcinoma

Bing Pan, Shaocheng Lyu, Xin Zhao, Lixin Li, Ren Lang, Qiang He†()   

  1. Department of Hepatobiliary, Pancreatic and Spleen Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2023-07-27 Published:2023-12-10
  • Corresponding author: Qiang He
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潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强. 淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 608-612.

Bing Pan, Shaocheng Lyu, Xin Zhao, Lixin Li, Ren Lang, Qiang He. Effect of number of dissected lymph nodes on efficacy of pancreaticoduodenectomy for distal cholangiocarcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 608-612.

目的

探讨淋巴结清扫数目对远端胆管癌胰十二指肠切除手术安全性及预后的影响。

方法

回顾性分析2015年1月至2021年12月在首都医科大学附属北京朝阳医院行胰十二指肠切除术的104例远端胆管癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男60例，女44例；年龄29~84岁，中位年龄66岁。分析淋巴结清扫数目对患者围手术期并发症及生存预后的影响。采用X-tile软件分析确定淋巴结数目临界值，根据临界值分为两组。两组淋巴结数目比较采用t检验，并发症发生率等比较采用χ2检验。生存分析采用Kaplan-Meier法和Log-rank检验。

结果

患者清扫淋巴结数目3~45个，依据淋巴结数目临界值24个，将患者分为两组，其中淋巴结数目<24个80例和淋巴结清扫数目≥24个24例。<24个组和≥24个组患者清扫出淋巴结数目分别为（15±5）、（31±6）个，差异有统计学意义（t=-13.101，P<0.05）；两组患者术后并发症发生率和围手术期死亡率分为21%（5/24）、4%（1/24）和21%（26/80）、5%（4/80），差异无统计学意义（χ2=1.201，0.142；P>0.05）；两组患者术后1、3、5年总体生存率分别为72.6%、33.2%、25.9%和87.1%、63.7%、63.7%，差异有统计学意义（χ2=6.170，P<0.05）。

结论

对于远端胆管癌胰十二指肠切除术患者，清扫淋巴结清扫数目≥24个可明显改善生存预后，且不会增加围手术期安全风险。

关键词: 胆管肿瘤, 胰十二指肠切除术, 淋巴结清扫, 手术后并发症, 预后
Objective

To evaluate the effect of the number of dissected lymph nodes on the safety and prognosis of pancreaticoduodenectomy for distal cholangiocarcinoma.

Methods

Clinical data of 104 patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy in Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2015 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 60 patients were male and 44 female, aged from 29 to 84 years, with a median age of 66 years. The effect of the number of dissected lymph nodes on perioperative complications and survival was evaluated. The threshold value of lymph node number was determined by X-tile software. All patients were divided into two groups according to the threshold value. The number of lymph nodes between two groups was compared by t test, and the incidence of complications was compared by Chi-square test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Results

The number of dissected lymph nodes was 3-45. According to the threshold value of 24 lymph nodes, all patients were divided into the <24 (n=80) and ≥24 groups (n=24). The number of dissected lymph nodes in the <24 group and ≥24 group was 15±5 and 31±6, and the difference was statistically significant (t=-13.101, P<0.05). The incidence of postoperative complications and perioperative mortality rate in two groups were 21%(5/24), 4%(1/24) and 21%(26/80), 5%(4/80), and the differences were not statistically significant (χ2=1.201, 0.142; P>0.05). The postoperative 1-, 3- and 5-year overall survival rates of patients in two groups were 72.6%, 33.2%, 25.9% and 87.1%, 63.7%, 63.7%, respectively, and the differences were statistically significant (χ2=6.170, P<0.05).

Conclusions

For patients with distal cholangiocarcinoma undergoing pancreatoduodenectomy, the number of dissected lymph nodes ≥24 can significantly improve clinical prognosis without sacrificing perioperative safety.

Key words: Bile duct neoplasms, Pancreatoduodenectomy, Lymph node dissection, Postoperative complications, Prognosis
表1 不同淋巴结清扫数目远端胆管癌胰十二指肠切除术患者基线资料比较
参数 <24个组 ≥24个组 统计值 P值
性别(例，男/女) 47/33 13/11 χ2=0.037 0.849
年龄(岁，±s) 66±8 64±11 t=1.101 0.274
糖尿病(例) 25 4 χ2=1.953 0.162
吸烟(例) 28 5 χ2=1.710 0.191
术前减黄术(例) 39 8 χ2=1.772 0.183
CA19-9[kU/L，M(QR)] 50（166） 62（98） Z=-0.845 0.398
TB[μmol/L，M(QR)] 125（203） 77（108） Z=0.536 0.592
组织分化(例，低/中/高) 22/39/19 6/11/7 χ2=0.292 0.864
肿瘤直径[cm，M(QR)] 2.0±0.8 2.3±1.1 t=-1.565 0.121
淋巴结转移（例） 29 8 χ2=0.069 0.794
R0切除 77 22 χ2=0.142 0.707
术后化疗（例） 31 7 χ2=0.731 0.393
表2 不同淋巴结清扫数目远端胆管癌胰十二指肠切除术患者围手术期情况比较
参数 <24个组 ≥24个组 统计值 P值
手术时间（h，±s) 9.5±1.7 9.5±1.6 t=0.207 0.837
术中出血量[ml，M(QR)] 500(200) 400(213) Z=1.501 0.133
输血（例） 27 6 χ2=0.653 0.419
总并发症（例） 26 5 χ2=1.201 0.273
死亡（例） 4 1 χ2=0.142 0.707
术后住院时间[d，M(QR)] 20(10) 21(5) Z=-0.150 0.880
B、C级胰瘘（例） 11 1 χ2=0.855 0.355
腹腔出血（例） 9 1 χ2=0.407 0.524
腹腔感染（例） 11 1 χ2=0.855 0.355
胃排空延迟（例） 3 1 χ2=0.262 0.609
图1 不同淋巴结清扫数目远端胆管癌胰十二指肠切除术患者Kaplan-Meier生存曲线注：1为≥24个组，2为<24个组
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