發(fā)布時(shí)間：2018-11-19 18:45

【摘要】：研究目的基于腹腔鏡胰十二指腸切除標(biāo)本,對(duì)胰腺系膜淋巴結(jié)的分布及轉(zhuǎn)移高危因素進(jìn)行分析,旨在發(fā)現(xiàn)與胰腺系膜淋巴結(jié)轉(zhuǎn)移的相關(guān)因素,以及其對(duì)生存期和復(fù)發(fā)率的影響,指導(dǎo)手術(shù)治療。研究方法回顧性分析2015年6月至2016年12月本團(tuán)隊(duì)完成的腹腔鏡胰十二指腸切除術(shù)時(shí)達(dá)到胰腺全系膜切除術(shù)的80例標(biāo)本。將胰腺系膜標(biāo)本分區(qū),探索胰腺系膜淋巴結(jié)分布,通過單因素分析各項(xiàng)可能因素對(duì)惡性腫瘤胰腺系膜及各分區(qū)淋巴結(jié)轉(zhuǎn)移的影響,各項(xiàng)因素包括:1)術(shù)前全身情況,年齡、性別、身高體重指數(shù)(Body Mass Index,BMI)、合并癥情況、有無黃疸、有無腹痛等;2)腫瘤相關(guān)因素,腫瘤位置、大小、腫瘤指標(biāo)等。隨訪患者生存狀況,采用Kaplan-Meier生存分析探討惡性腫瘤患者胰腺系膜淋巴結(jié)轉(zhuǎn)移對(duì)生存狀態(tài)的影響。研究結(jié)果2015年6月至2016年12月本團(tuán)隊(duì)完成腹腔鏡胰十二指腸切除術(shù)全系膜切除術(shù)80例,圍手術(shù)期死亡病例1例。根據(jù)術(shù)后病理結(jié)果,惡性55例,良性25例。針對(duì)惡性腫瘤病例進(jìn)行單因素分析提示,術(shù)前狀況(年齡、性別、BMI、有無高血壓、有無糖尿病、有無黃疸、有無腹痛)、腫瘤相關(guān)因素(腫瘤位置、大小、CA19-9、CA125、CEA、外周血粒淋比(NLR))與胰腺系膜各分區(qū)淋巴結(jié)轉(zhuǎn)移均無顯著相關(guān)。中位隨訪時(shí)間9個(gè)月,Kaplan-Meier生存分析提示,胰腺系膜淋巴結(jié)轉(zhuǎn)移、血管區(qū)系膜淋巴結(jié)轉(zhuǎn)移均與惡性腫瘤患者的短期生存率和復(fù)發(fā)轉(zhuǎn)移顯著相關(guān)。復(fù)發(fā)類型與胰腺系膜淋巴結(jié)轉(zhuǎn)移及各分區(qū)淋巴結(jié)轉(zhuǎn)移無明顯相關(guān)性。結(jié)論胰腺系膜是惡性腫瘤淋巴結(jié)轉(zhuǎn)移的區(qū)域之一。胰腺系膜淋巴結(jié)轉(zhuǎn)移提示患者預(yù)后不良。血管區(qū)系膜淋巴結(jié)轉(zhuǎn)移與惡性腫瘤患者的短期生存率及復(fù)發(fā)轉(zhuǎn)移顯著相關(guān)。
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.9
，

本文編號(hào)：2343106