三维可视化技术在胰头癌胰腺全系膜切除术中应用研究
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摘要
目的探讨三维可视化技术在胰头癌胰腺全系膜切除术中的应用价值。方法回顾性分析2013年1月至2017年6月在上海交通大学医学院附属新华医院普外科行胰腺全系膜切除的105例胰头癌病人资料,采用三维可视化技术对胰头肿瘤的部位、大小、与周围血管的毗邻关系进行观察,完成术前可切除性的评估,共施行胰腺全系膜切除术105例。结果平均手术时间239 min,平均术中出血409 mL。29例(27.6%)发生术后并发症,无围手术期死亡病例。74例标本三维空间切缘病理学检查达到R0切除,R0切除率为70.5%。结论三维可视化技术在胰头癌全系膜切除术前规划中的应用,可以更好地指导胰头癌的精准手术,提高了术前评估的准确率与手术的R0切除率,降低手术并发症发生率。
Objective To evaluate the application of three-dimensional visualization technique in total mesopancreas excision(TMpE) for pancreatic head carcinoma. Methods From January 2013 to June 2017, 105 TMpE for pancreatic head carcinoma were performed in our institution, and clinical data of these cases were analyzed retrospectively. In order to evaluate the feasibility of operation, three-dimensional visualization techniques were applied to observe the site and size of the pancreatic head tumors, and the relationship between the tumors and peripancreatic vessels before the operation. Results The median operation time was 239 minutes, and the median blood loss was 409 mL. 29 cases with postoperative complications and no perioperative deaths. 74 patients were considered as R0 resection in final threedimensional pathologic examination, and the rate of R0 resection is 70.5%. Conclusion Preoperative application of three-dimensional visualization technique in TMpE can improve preoperative assessment accuracy and increase the rate of R0 resection, in addition to reduce postoperative complications.
Objective To evaluate the application of three-dimensional visualization technique in total mesopancreas excision(TMpE) for pancreatic head carcinoma. Methods From January 2013 to June 2017, 105 TMpE for pancreatic head carcinoma were performed in our institution, and clinical data of these cases were analyzed retrospectively. In order to evaluate the feasibility of operation, three-dimensional visualization techniques were applied to observe the site and size of the pancreatic head tumors, and the relationship between the tumors and peripancreatic vessels before the operation. Results The median operation time was 239 minutes, and the median blood loss was 409 mL. 29 cases with postoperative complications and no perioperative deaths. 74 patients were considered as R0 resection in final threedimensional pathologic examination, and the rate of R0 resection is 70.5%. Conclusion Preoperative application of three-dimensional visualization technique in TMpE can improve preoperative assessment accuracy and increase the rate of R0 resection, in addition to reduce postoperative complications.
引文
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[3]杨尹默.胰十二指肠切除术中淋巴结清扫范围争议与共识[J].中国实用外科杂志,2016,36(8):843-846.
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[12]中华医学会外科学分会胰腺外科学组,中华外科杂志编辑部.胰腺术后外科常见并发症预防及治疗的专家共识(2010)[J].中华外科杂志,2010,48(18):1365-1368.
[13]张太平,展翰翔,赵玉沛.做好“胰腺癌术前可切除性评估”[J].中华肝胆外科杂志,2010,16(2):81-84.
[14]中华医学会外科学分会胰腺外科学组.胰腺癌诊治指南(2014)[J].中国实用外科杂志,2014,34(11):1011-1017.
[15]Callery MP,Chang KJ,Fishman EK,et al.Pretreatment assessment of resectable and borderline resectable pancreatic cancer:Expert consensus statement[J].Ann Surg Oncol,2009,16(7):1727-1733.
[16]Klauss M,Sch?binger M,Wolf I,et al.Value of three-dimensional reconstructions in pancreatic carcinoma using multidetector CT:Initial results[J].World J Gastroenterol,2009,15(46):5827-5832.
[17]Gockel I,Domeyer M,Wolloscheck T,et al.Resection of the mesopancreas(RMP):A new surgical classification of a known anatomical space[J].World J Surg Oncol,2007,5(44):1-8.
[18]Bouassida M,Mighri MM,Chtourou MF,et al.Retroportal lamina or mesopancreas?Lessons learned by anatomical and histological study of thirty three cadaveric dissections[J].Int JSurg,2013,11(9):834-836.
[19]Gaedcke J,Gunawan B,Grade M,et al.The mesopancreas is the primary site for R1 resection in pancreatic head cancer:Relevance for clinical trials[J].Langenbecks Arch Surg,2010,395(4):451-458.
[20]刘颖斌,吴文广.胰腺全系膜切除理念争议及评价[J].中国实用外科杂志,2016,36(8):836-838.
[21]中华医学会外科学分会胰腺外科学组,中国研究型医院学会胰腺疾病专业委员会,中华医学会数字医学分会,中国研究型医院学会数字医学临床外科专业委员会.胰头癌三维可视化精准诊治专家共识[J].中华外科杂志,2017,55(12):881-886.
[2]Tol JA,Gouma DJ,Bassi C,et al.Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma:A consensus statement by the International Study Group on Pancreatic Surgery(ISGPS)[J].Surgery,2014,156(3):591-600.
[3]杨尹默.胰十二指肠切除术中淋巴结清扫范围争议与共识[J].中国实用外科杂志,2016,36(8):843-846.
[4]吴向嵩,刘颖斌.胰头癌区域淋巴结清扫的范围与理念[J].中华消化外科杂志,2014,13(11):909-912.
[5]Lee ES,Lee JM.Imaging diagnosis of pancreatic cancer:A stateof-the-art review[J].World J Gastroenterol,2014,20(24):7864-7877.
[6]Adhama M,Singhirunnusorn J.Surgical technique and results of tota lmesopancreas excision(TMp E)in pancreatic tumors[J].Eur J Surg Oncol,2012,38(4):340-345.
[7]吴文广,吴向嵩,李茂岚,等.胰头癌行胰腺全系膜切除75例报告[J].中国实用外科杂志,2013,33(10):859-862.
[8]Peng SY,Wang JW,Lau WY,et al.Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy:aprospective randomized trial[J].Ann Surg,2007,245(5):692-698.
[9]Buc E,Flamein R,Golffier C,et al.Peng's binding pancreaticojejunostomy after pancreaticoduodenectomy:a French prospective study[J].J Gastrointest Surg,2010,14(4):705-710.
[10]Peng SY,Wang JW,Hong de F,et al.Binding pancreaticoenteric anastomosis:from binding pancreaticojejunostomy to binding pancreaticogastrostomy[J].Updates Surg,2011,63(2):69-74.
[11]Loyer EM,David CL,Dubrow RA,et al.Vascular involvement in pancreatic adenocarcinoma:reassessment by thin-section CT[J].Abdom Imaging,1996,21(3):202-206.
[12]中华医学会外科学分会胰腺外科学组,中华外科杂志编辑部.胰腺术后外科常见并发症预防及治疗的专家共识(2010)[J].中华外科杂志,2010,48(18):1365-1368.
[13]张太平,展翰翔,赵玉沛.做好“胰腺癌术前可切除性评估”[J].中华肝胆外科杂志,2010,16(2):81-84.
[14]中华医学会外科学分会胰腺外科学组.胰腺癌诊治指南(2014)[J].中国实用外科杂志,2014,34(11):1011-1017.
[15]Callery MP,Chang KJ,Fishman EK,et al.Pretreatment assessment of resectable and borderline resectable pancreatic cancer:Expert consensus statement[J].Ann Surg Oncol,2009,16(7):1727-1733.
[16]Klauss M,Sch?binger M,Wolf I,et al.Value of three-dimensional reconstructions in pancreatic carcinoma using multidetector CT:Initial results[J].World J Gastroenterol,2009,15(46):5827-5832.
[17]Gockel I,Domeyer M,Wolloscheck T,et al.Resection of the mesopancreas(RMP):A new surgical classification of a known anatomical space[J].World J Surg Oncol,2007,5(44):1-8.
[18]Bouassida M,Mighri MM,Chtourou MF,et al.Retroportal lamina or mesopancreas?Lessons learned by anatomical and histological study of thirty three cadaveric dissections[J].Int JSurg,2013,11(9):834-836.
[19]Gaedcke J,Gunawan B,Grade M,et al.The mesopancreas is the primary site for R1 resection in pancreatic head cancer:Relevance for clinical trials[J].Langenbecks Arch Surg,2010,395(4):451-458.
[20]刘颖斌,吴文广.胰腺全系膜切除理念争议及评价[J].中国实用外科杂志,2016,36(8):836-838.
[21]中华医学会外科学分会胰腺外科学组,中国研究型医院学会胰腺疾病专业委员会,中华医学会数字医学分会,中国研究型医院学会数字医学临床外科专业委员会.胰头癌三维可视化精准诊治专家共识[J].中华外科杂志,2017,55(12):881-886.