胰头癌区域性淋巴结清扫的临床价值分析

  目的  总结胰头癌区域性淋巴结清扫的资料，分析淋巴结转移的特点及其临床应用价值。  方法  回顾性总结和统计复旦大学附属肿瘤医院2010年2月至2013年10月160例胰头导管腺癌行淋巴结清扫标本中的淋巴结分站分组情况，探讨各种临床因素与淋巴结转移的关系；统计16组淋巴结转移患者病历资料，探讨淋巴结清扫的临床意义。  结果  160例胰头癌患者经术后病理诊断均为导管腺癌，72.5%患者存在淋巴结转移（116例共656枚淋巴结转移），其中26例患者伴有16组淋巴结转移。淋巴结转移与性别、年龄、肿瘤大小和肿瘤分化程度均无关，但与肿瘤临床分期有关。26例16组淋巴结转移的患者中，均为16b1亚组。淋巴结阴性的患者、淋巴结阳性但16组淋巴结阴性的患者，以及16组淋巴结阳性的患者，其术后中位生存期分别为25.6、17.25和10.95个月（P < 0.001）。16b1组淋巴结转移同时CA19-9>370 U/mL患者生存期较短。  结论  胰头癌淋巴结清扫时需合理清扫16b1淋巴结。 

Clinical value of regional lymph node resection in pancreatic head carcinoma

  Objective  To investigate the characteristics and clinical value of lymph node metastasis according to the clinical data of regional lymph node resection in pancreatic head carcinoma.  Methods  We summarized and statistically analyzed the lymph node numbers in lymph node dissection specimens of 160 cases of pancreatic duct adenocarcinoma from February 2010 to October 2013 in Fudan University, Shanghai Cancer Center retrospectively and explored the relationship between various clinical factors and lymph node metastasis; and summarized the clinical data in group 16 lymph node metastasis of the patients and investigated the clinical significance of lymph node dissection in these patients.  Results  After the pathological diagnosis of pancreatic adenocarcinoma, 72.5% of all the 160 patients had lymph node metastasis (116 cases of 656 lymph node metastases). Among them, 26 patients had group 16 lymph node metastasis. Lymph node metastasis was not related to gender, age, tumor size, or differentiation, but related to tumor clinical staging. In this study, we found that the lymph node metastasis in group 16 was in subgroup 16b1. patients without lymph nodes metastasis, patients with lymph nodes metastasis while without group 16 lymph nodes metastasis and patients with both lymph nodes metastasis and group 16 lymph nodes metastasis, the postoperative median survival time was 25.6 months, 17.25 months and 10.95 months, respectively (P < 0.001). Patients with lymph node metastasis in subgroup 16b1 and cancer antigen 19-9>370 U/mL had a shorter survival period.  Conclusions  Proper subgroup 16b1 lymph node resection is necessary for radical pancreaticoduodenectomy.