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。

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。

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）。

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。

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

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.

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).

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