腹腔镜胰十二指肠切除标本胰腺系膜淋巴结转移相关因素分析及其意义

发布时间：2018-11-19 18:45

【摘要】：研究目的基于腹腔镜胰十二指肠切除标本,对胰腺系膜淋巴结的分布及转移高危因素进行分析,旨在发现与胰腺系膜淋巴结转移的相关因素,以及其对生存期和复发率的影响,指导手术治疗。研究方法回顾性分析2015年6月至2016年12月本团队完成的腹腔镜胰十二指肠切除术时达到胰腺全系膜切除术的80例标本。将胰腺系膜标本分区,探索胰腺系膜淋巴结分布,通过单因素分析各项可能因素对恶性肿瘤胰腺系膜及各分区淋巴结转移的影响,各项因素包括:1)术前全身情况,年龄、性别、身高体重指数(Body Mass Index,BMI)、合并症情况、有无黄疸、有无腹痛等;2)肿瘤相关因素,肿瘤位置、大小、肿瘤指标等。随访患者生存状况,采用Kaplan-Meier生存分析探讨恶性肿瘤患者胰腺系膜淋巴结转移对生存状态的影响。研究结果2015年6月至2016年12月本团队完成腹腔镜胰十二指肠切除术全系膜切除术80例,围手术期死亡病例1例。根据术后病理结果,恶性55例,良性25例。针对恶性肿瘤病例进行单因素分析提示,术前状况(年龄、性别、BMI、有无高血压、有无糖尿病、有无黄疸、有无腹痛)、肿瘤相关因素(肿瘤位置、大小、CA19-9、CA125、CEA、外周血粒淋比(NLR))与胰腺系膜各分区淋巴结转移均无显著相关。中位随访时间9个月,Kaplan-Meier生存分析提示,胰腺系膜淋巴结转移、血管区系膜淋巴结转移均与恶性肿瘤患者的短期生存率和复发转移显著相关。复发类型与胰腺系膜淋巴结转移及各分区淋巴结转移无明显相关性。结论胰腺系膜是恶性肿瘤淋巴结转移的区域之一。胰腺系膜淋巴结转移提示患者预后不良。血管区系膜淋巴结转移与恶性肿瘤患者的短期生存率及复发转移显著相关。
[Abstract]:Objective to analyze the distribution of pancreatic Mesangial lymph nodes and the high risk factors of metastasis based on laparoscopic pancreaticoduodenectomy, in order to find out the factors related to the metastasis of pancreatic Mesangial lymph nodes, and its influence on the survival time and recurrence rate of pancreatic Mesangial lymph nodes. To guide the surgical treatment. Methods A retrospective analysis of 80 cases of total mesenteric pancreatectomy performed by our team during laparoscopic pancreaticoduodenectomy from June 2015 to December 2016 was performed. To study the distribution of mesenteric lymph nodes in pancreatic Mesangial specimens, the possible factors affecting the metastasis of pancreatic Mesangium and lymph nodes in malignant tumors were analyzed by single factor analysis. The factors included: 1) preoperative systemic condition, age, and age. Gender, body mass index (Body Mass Index,BMI), complications, jaundice, abdominal pain, etc. 2) tumor related factors, tumor location, size, tumor index and so on. To investigate the influence of pancreatic Mesangial lymph node metastasis on survival status by Kaplan-Meier survival analysis. Results from June 2015 to December 2016, 80 patients underwent laparoscopic pancreatoduodenectomy and 1 died during perioperative period. According to postoperative pathological results, 55 cases were malignant and 25 cases were benign. Univariate analysis of malignant tumor cases showed that preoperative status (age, sex, BMI, hypertension, diabetes mellitus, jaundice, abdominal pain), tumor-related factors (tumor location, size, CA19-9,CA125,CEA,) There was no significant correlation between peripheral blood granulocyte ratio (NLR) and lymph node metastasis. The median follow-up time was 9 months. Kaplan-Meier survival analysis showed that Mesangial lymph node metastasis and vascular Mesangial lymph node metastasis were significantly correlated with the short-term survival rate and recurrence and metastasis in patients with malignant tumors. There was no significant correlation between recurrence type and pancreatic Mesangial lymph node metastasis and regional lymph node metastasis. Conclusion Pancreatic Mesangium is one of the regions of lymph node metastasis in malignant tumors. Pancreatic Mesangial lymph node metastasis suggests poor prognosis. Vascular Mesangial lymph node metastasis was significantly associated with short-term survival rate and recurrence and metastasis in patients with malignant tumors.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9
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本文编号：2343106