本文選題：胰體尾腫瘤 + 微創(chuàng)手術(shù)��； 參考：《北京協(xié)和醫(yī)學院》2017年博士論文

【摘要】：研究背景消化系統(tǒng)腫瘤WHO分類將胰腺腫瘤主要分為以下八類:漿液性囊性腫瘤、粘液性囊性腫瘤、導管內(nèi)乳頭狀粘液性腫瘤、神經(jīng)內(nèi)分泌腫瘤、實性假乳頭狀瘤、導管腺癌、腺泡細胞癌和轉(zhuǎn)移癌。根據(jù)其生物學行為不同通常又將前5類腫瘤列為良性及低度惡性腫瘤;后3種列為典型的惡性腫瘤。近年來,隨著人們健康體檢意識的增強以及影像學技術(shù)的進步與普及,胰腺腫瘤性疾病的檢出率逐年升高,其中胰腺囊性腫瘤尤為明顯。胰體尾部的腫瘤約占所有胰腺腫瘤的50%;對于該部分病例,大都需行胰腺體尾部切除術(shù)。研究目的1、建立北京協(xié)和醫(yī)院胰體尾切除病例電子數(shù)據(jù)庫,實現(xiàn)病例統(tǒng)一管理和隨訪。2、研究比較微創(chuàng)與開腹胰體尾切除的手術(shù)相關(guān)指標和術(shù)后短期并發(fā)癥。3、研究胰體尾切除中脾臟保留與術(shù)后并發(fā)癥的關(guān)系,以及脾臟保留的影響因素。4、研究胰體尾切除術(shù)后遠期的并發(fā)癥及其影響因素。5、研究胰體尾部導管腺癌手術(shù)方式及其與預后的相關(guān)性。研究方法通過建立北京協(xié)和醫(yī)院胰體尾切除病例的電子數(shù)據(jù)庫,基于大數(shù)據(jù)分析對上述五方面的問題分別進行探討。采用傾向性評分匹配(PSM)和意向性(ITT)的統(tǒng)計學處理方法,盡可能降低選擇偏倚和術(shù)中組間中轉(zhuǎn)對研究結(jié)果的影響;采用單因素和多因素分析篩選影響胰體尾切除術(shù)后新發(fā)糖尿病的潛在危險因素;采用Logistics回歸模型擬合胰體尾術(shù)后糖尿病綜合風險評分公式;采用Cox回歸模型分析胰體尾部導管腺癌病例生存期的影響因素。研究結(jié)果1、成功建立北京協(xié)和醫(yī)院胰體尾切除病例電子數(shù)據(jù)庫,為后續(xù)研究提供了統(tǒng)一平臺;胰體尾切除病例中,良性及低度惡性腫瘤占65%,導管腺癌等惡性腫瘤占35%;最常見的5種病理類型為導管腺癌、神經(jīng)內(nèi)分泌腫瘤、粘液性囊腺瘤、漿液性囊腺瘤和實性假乳頭狀瘤。2、對于胰體尾切除術(shù),微創(chuàng)手術(shù)較開腹具有手術(shù)出血少、術(shù)中輸血比例低、術(shù)后恢復進食早和住院時間短的特點,可減少手術(shù)創(chuàng)傷、加速病人術(shù)后康復;BMI高和腫瘤直徑偏大是微創(chuàng)手術(shù)中轉(zhuǎn)開腹的獨立危險因素。3、保留脾臟胰體尾切除術(shù)的手術(shù)時間、手術(shù)出血量和術(shù)中輸血比例明顯小于聯(lián)合脾臟切除組;但二者在術(shù)后短期并發(fā)癥方面無顯著差異;腫瘤直徑3cm可作為脾臟血管保留的獨立預測因素。4、年齡、BMI、手術(shù)出血量、是否保留脾臟、腫瘤部位和切除胰腺總長度為胰體尾切除術(shù)后新發(fā)糖尿病的獨立危險因素;首次在大型隊列研究中證實胰體尾切除中保留脾臟有利于降低病人術(shù)后糖尿病的發(fā)生風險;首次建立糖尿病風險評分公式可較好地預測胰體尾切除后糖尿病的發(fā)生。5、根治性順行模塊胰體尾加脾切除術(shù)可提高胰體尾導管腺癌的手術(shù)切緣陰性率,增加淋巴結(jié)清掃數(shù)目,降低局部復發(fā)率,并且顯著延長病人的無病生存期和總體生存期;與開腹胰體尾癌切除術(shù)相比,微創(chuàng)手術(shù)可加速患者術(shù)后康復,但并未降低其腫瘤切除的安全性。研究結(jié)論電子病例數(shù)據(jù)庫的建立可為臨床研究提供了統(tǒng)一規(guī)范的平臺;微創(chuàng)技術(shù)可促進胰體尾切除病人的快速恢復,但并未降低胰體尾導管腺癌的腫瘤切除安全性;良性和低度惡性腫瘤中保留脾臟可減少手術(shù)創(chuàng)傷,并降低術(shù)后新發(fā)糖尿病風險;糖尿病風險評分公式可較好地預測胰體尾切除后糖尿病的發(fā)生;根治性順行模塊胰體尾加脾切除術(shù)安全可行,可降低胰體尾癌的局部復發(fā)率,并顯著延長病人的總體生存期。
[Abstract]:Background WHO classification of tumors in the digestive system divides pancreatic tumors into eight main categories: serous cystic tumors, mucinous cystic tumors, intraductal papillary mucinous tumors, neuroendocrine tumors, real pseudopapillary tumors, ductal adenocarcinoma, acinar cell carcinoma and metastatic carcinoma. According to their biological behavior, the first 5 types of tumors are commonly used. In recent years, with the enhancement of health examination consciousness and the progress and popularization of imaging technology, the detection rate of pancreatic tumor disease is increasing year by year, especially the cystic tumor of pancreas is more obvious. The tumor of the tail of pancreas accounts for about 50% of all pancreatic tumors. In this part of the cases, most of the cases of pancreatectomy are required. Objective 1 to establish an electronic database of the cases of the tail resection of pancreas in Peking Union Medical College Hospital, to realize the unified management of cases and follow up.2, to compare the related indexes of minimally invasive and open pancreatectomy and to study the short-term postoperative onset of.3. The relationship between the complications and the factors affecting the retention of the spleen.4. The long-term complications and its influencing factors after the tail of the pancreatectomy were studied.5. The surgical methods and the correlation with the prognosis of the duct adenocarcinoma of the body and tail of the pancreas were studied. The five aspects of the above-mentioned problems were discussed respectively. The statistical methods of PSM and ITT were used to reduce the effect of selection bias and inter group transfer on the results of the study. Logistics regression model was used to fit the comprehensive risk score formula of diabetes after body and tail surgery, and Cox regression model was used to analyze the influencing factors of the survival period of pancreatic duct adenocarcinoma cases. Results 1, the electronic database of the case of pancreatic body tail resection in Peking Union Medical College Hospital was successfully established, which provided a unified platform for the follow-up study. Benign and low grade malignant tumors accounted for 65%, and malignant tumor of ductal adenocarcinoma accounted for 35%; the most common 5 pathological types were ductal adenocarcinoma, neuroendocrine tumor, mucinous cystadenoma, serous cystadenoma and real pseudopapillary tumor.2, for caudal pancreatectomy, minimally invasive surgery had less bleeding, lower intraoperative blood transfusion, and lower postoperative blood transfusion. The characteristics of early recovery and short hospitalization can reduce the surgical trauma and accelerate the recovery of the patients. The BMI height and the large diameter of the tumor are the independent risk factor.3 for the minimally invasive surgery, preserving the operation time of the splenectomy, and the amount of bleeding and intraoperative blood transfusion is significantly lower than that of the combined splenectomy group; but the two are in the operation. There was no significant difference in the post short-term complications. The tumor diameter 3cm could be used as an independent predictor of the retention of the spleen,.4, age, BMI, the amount of bleeding, the retention of the spleen, the site of the tumor and the total length of the pancreas as an independent risk factor for new onset diabetes after the tail resection of the pancreas; the first in a large cohort study to confirm the tail cut of the body. In addition, the retention of spleen is beneficial to reduce the risk of postoperative diabetes. The first establishment of the diabetes risk score formula can better predict the incidence of diabetes after the tail of the pancreatectomy.5. The radical resection of the pancreatic body tail plus splenectomy can improve the negative rate of the surgical margin, increase the number of lymph node dissection and decrease the number of lymph node dissection. The low local recurrence rate, and significantly prolongs the patient's disease-free life and the overall life period; compared with the operation of the open caudal carcinoma of the pancreas, minimally invasive surgery can accelerate the postoperative recovery of the patients, but does not reduce the safety of the tumor resection. The technique can promote the rapid recovery of the patients with pancreatic tail resection, but it does not reduce the safety of the tumor resection of the caudal duct adenocarcinoma of the pancreas. The retention of the spleen in benign and low malignant tumors can reduce the surgical trauma and reduce the risk of new onset diabetes after the operation; the diabetes risk score formula can be used to predict the occurrence of diabetes after the tail of pancreatic body and tail excision; Treatment of antegrade pancreatic body tail and splenectomy is safe and feasible, which can reduce the local recurrence rate of the carcinoma of the body and tail of the pancreas, and significantly prolong the overall survival of the patients.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R735.9

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