文章摘要
仇爱峰,王学斌,王立胜,施育华.无接触分离技术在胰头癌根治性切除术中应用价值探讨[J].南京医科大学学报,2010,(11):1644~1648
无接触分离技术在胰头癌根治性切除术中应用价值探讨
Value of no-touch isolation technique in radical resection for pancreatic head adenocarcinoma
投稿时间:2010-05-27  
DOI:10.7655
中文关键词: 胰头癌  胰十二指肠切除术  无接触分离技术  角蛋白  肝转移
英文关键词: pancreatic head carcinoma  pancreaticoduodenectomy  NTIT  cytokeratin  liver metastasis
基金项目:
作者单位
仇爱峰 东南大学医学院附属盐城医院普通外科,江苏 盐城 224001 
王学斌 东南大学医学院附属盐城医院普通外科,江苏 盐城 224001 
王立胜 东南大学医学院附属盐城医院普通外科,江苏 盐城 224001 
施育华 东南大学医学院附属盐城医院普通外科,江苏 盐城 224001 
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中文摘要:
      目的: 研究无接触分离技术(no-touch isolation technique,NTIT)在胰头癌根治性切除术中的应用,探讨以NTIT技术为重点的胰十二指肠切除术对肿瘤转移及预后的影响?方法:对2004年2月~2009年9月施行胰十二指肠切除术的57例胰头癌患者进行对照研究?其中NTIT组32例,常规手术组25例?测定手术病例肿瘤切除前?后门静脉血细胞角蛋白20(CK20) mRNA表达情况?分析两组生存期?肝转移率和死亡率?结果:两组患者术后并发症发生率无明显差异?切除肿瘤病灶前,门静脉血内CK20 mRNA 的阳性表达率常规手术组和NTIT组分别为16.00%?18.75%,无统计学差异?肿瘤切除后,常规手术组CK20 mRNA的阳性率显著高于NTIT组(52.00% vs. 25.00%,P=0.036)?术后随访,NTIT组?常规手术组术后1?3?5年生存率分别为76.6%?50.0%?40.0%和75.0%?33.3%?8.8%?NTIT组5年生存率高于常规手术组(P=0.018)?术后死亡原因分析显示NTIT组肝转移率显著低于常规手术组(P=0.024)?结论: 胰头癌根治性切除术中采用NTIT技术能有效减少癌细胞播散,减少术后肝转移发生率,改善预后?
英文摘要:
      Objective: To evaluate the long-term effect of pancreaticoduodenectomy with no-touch isolation technique. Methods:Fifty-seven patients with ductal adenocarcinoma in the pancreatic head treated from 2004 to 2009 in Yancheng hospital were studied retrospectively. The patients were divided into two groups: NTIT(group A,n=32) and conventional techniques (group B,n=25). Blood samples(10 ml) were obtained through a catheter in the portal vein to detect CK20 mRNA expression by RT-PCR before and after surgery. The survival rate, liver metastasis rate and mortality were compared between the two groups. Results: As far as the mean volume of blood loss and the postoperative complications, there were no significant difference in the two groups(P=0.791,P > 0.05). Before the tumor resection, the overall positive rate of CK20 mRNA expression in portal vein blood was 17.54 %(10/54) , including 16.00% in conventional group and 18.75 % in NTIT group. This difference wasn't statistically significant(P=0.786,P > 0.05). After surgery, in 13 out of 25 cases (52.00%) of the conventional procedure group, CK20 mRNA was identified in the portal blood, while only 8 out of 32 cases (25.00%) was positive for portal CK20 mRNA in the NTIT group(P=0.024, P < 0.05). The survival rates of 1-, 3-, 5-year in group B were 76.6%,50.0%,40.0%, respectively, which were higher than those in group A. The rate of liver metastasis was significantly higher in group B than in group A(P=0.024, P < 0.05). Conclusion:In pancreatic cancer, the operation could cause the dissemination of cancer cells. The no-touch isolation technique may be a potential operative procedure to prevent cancer cells from being shed into the portal vein during surgical manipulation. NTIT could reduce the rate of liver metastasis so as to improve the long-term survival rate.
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