The Value Of Total Mesopancreas Excision In Pancreatoduodenectomy

Objective:To evaluate the clinical significance and application about total mesopancreas excision(TMp E)in patient with vater ampulla carcinoma and pancreatic head carcinoma underwent pancreatoduodenectomy(PD).Methods:Retrospective analysis 57 cases of patients from January 2014 to January 2016 in Fujian Provincial Medical College of Fujian Medical University underwent PD for periampullary carcinoma and pancreatic head carcinoma.December 30,2016 or death as the end point collected all patients information including clinical manifestations,biochemical and tumor index.At the same time according to the intraoperative lymph node dissection whole patients is divided into for TMp E group(37 cases)and standard lymph node dissection group(20 cases),two groups of operation time,intraoperative hemorrhage,red blood cell transfusion volume,postoperative complications,hospitalization time and lymph node status were statistically analyzed.Results:There were pancreatic head cancer in 18 cases,papillary carcinoma of duodenum in 23 cases,carcinoma of lower end of common bile duct in 5 cases,ampullary carcinoma 11 cases.Compared with 57 cases of periampullary carcinoma and pancreatic head carcinoma,jaundice is a common starting symptoms.Contrast in the two groups of patients' age,gender,biochemical,and pathological type found showed no statistically significant difference(P > 0.05),TMp E group and standard lymph node dissection group in the operation time(373.5±89.5 VS 331.6±72.2,P>0.05),intraoperative hemorrhage(450.0±263.0 VS 399.0±186.0,P>0.05),red blood cell transfusion volume during operation(227.0±350.1 VS 200.0±275.3,P>0.05),the average hospitalization time(33.1±11.4 VS 29.2±9.7,P>0.05)were not statistically significant,the complications of two groups have no statistical differences,but TMp E group the incidence rate of 73%,while the standard lymph node dissection group was 50%,after the effective intervention measures,two groups of patients with postoperative complications were better improved,the patients in the two groups were no perioperative death.The number of negative lymph nodes in the two groups of lymph node positive patients was statistically significant,and there were 2 cases of ampullary carcinoma and 1 cases of duodenal papillary carcinoma fouded 16 groups lymph node metastasis in the TMp E group,,the total number of detected pancreatic lymph nodes in total mesorectal excision group(23.9±10.1)was higher than the standard lymph node dissection group(15.6±5.3),the difference between the two groups was statistically significant.Conclusion:Periampullary carcinoma and pancreatic head carcinoma received PD surgery use TMp E is safe and feasible,Patients with periampullary carcinoma,especially in the presence of the surrounding tissue invasion situation,suggested for TMp E.All patients underwent total mesorectal excision to increase the resection rate of lymph nodes,but the long-term prognosis is still needed to further study.