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目的:比较转化治疗后动脉受累局部进展期胰腺癌患者手术中使用动脉预阻断技术（APOT）与传统技术的临床效果。方法:本研究为回顾性队列研究。回顾性分析2020年1月至2022年12月海军军医大学第一附属医院肝胆胰脾外科收治的145例动脉受累局部进展期胰腺癌患者的临床资料。所有患者完成肿瘤新辅助治疗，术前通过多学科协作团队评估确定可行根治性手术治疗。根据术中是否采用APOT分为两组，其中APOT组28例［男性16例，女性12例，年龄（59.0±9.4）岁］，常规手术组117例［男性76例，女性41例，年龄（55.1±8.2）岁］。为了确保APOT组和常规手术组基线数据的可比性，采用倾向性评分匹配法对两组的基本资料进行1︰2匹配，卡钳值为0.006 45。通过 t检验、Mann-Whitney U检验、 χ2检验或Fishier确切概率法对两组患者手术情况、住院时间、术后并发症、术后病理学检查结果及预后等指标进行比较。 结果:倾向性评分匹配后，APOT组28例，常规手术组56例。两组患者性别、年龄、术前基础疾病、术前体重指数、手术方式、化疗方案、体部立体定向放疗比例、肿瘤标志物水平、受侵动脉类型等一般资料的差异均无统计学意义（ P值均>0.05）。APOT组动脉阻断时间［ M（IQR）］7.0（3.8）min（范围：3~15 min），术后未观察到阻断血管的远端靶器官有缺血表现。APOT组的手术时间为（170.3±57.7）min，常规手术组为（235.0±80.2）min，差异有统计学意义（ t=-3.800， P<0.01）。与常规手术组［800（600）ml］相比，APOT组［650（588）ml］的术中出血量少（ U=1 026.500， P=0.021）。两组患者术中联合静脉切除重建比例、联合腹腔干切除比例、术后近期并发症情况、30 d内再入院率、术后住院天数等指标的差异均无统计学意义（ P值均>0.05）。所有患者均行受累动脉鞘外剥离，其中联合动脉切除重建3例：APOT组2例，切除重建肠系膜上动脉1例，切除重建肝总动脉1例；常规手术组1例。术后发生腹腔出血4例，其中常规手术组3例，APOT组1例；常规手术组发生院内死亡1例。APOT组的根治性切除率为85.7%（24/28），常规手术组为80.4%（45/56），两组差异无统计学意义（ P=0.763）。APOT组中位总体生存时间为27.6个月，中位无病生存时间为11.7个月；常规手术组中位总体生存时间为 22.5个月，中位无病生存时间为16.8个月；两组总体生存时间和无病生存时间的差异均无统计学意义（ P=0.532， P=0.927）。 结论:在动脉受累的局部进展期胰腺癌患者术中使用APOT行动脉鞘外剥离是可行的，可缩短手术时间，减少术中出血量。

Objective:To investigate and compare the clinical outcomes of the arterial pre-occlusion technique(APOT) and the traditional technique in the surgery of locally advanced pancreatic cancer with arterial involvement after conversion therapy.Methods:This is a retrospective cohort study. The clinical data of 145 patients with locally advanced pancreatic cancer with arterial involvement admitted to the Department of Hepato-Biliary-Pancreatic Surgery of the First Hospital Affiliated to Naval Medical University,from January 2020 to December 2022 were retrospectively analyzed. All patients completed neoadjuvant therapy for tumors, and the feasibility of radical surgical treatment was determined by a multidisciplinary collaborative team evaluation before surgery. According to whether the intraoperative artery was pre-occluded, 145 patients were divided into two groups, including 28 cases in the APOT group(16 males, 12 females, aged (59.0±9.4) years), and 117 cases in the routine surgery group(76 males, 41 females, aged (55.1±8.2) years). To ensure comparability of baseline data between the APOT group and the routine surgery group,a 1︰2 match was performed using the propensity score matching method,and the caliper value was 0.006 45. The t-test,the Mann-Whitney U test, χ2 test or Fishier′s exact test were used to compare the data between the two groups,respectively. Results:After matching the propensity score,there were 28 cases in the APOT group and 56 cases in the routine surgery group. There were no significant differences in gender,age,preoperative comorbidities,preoperative body mass index,surgical approaches,chemotherapy regimen,stereotactic body radiation therapy ratio,tumor markers,and type of invaded artery between the two groups (all P>0.05).The arterial occlusion time M(IQR) in the APOT group was 7.0(3.8)minutes(range:3 to 15 minutes),and no ischemic manifestations were observed in the distal target organs that blocked blood vessels after surgery. The operation time was (170.3±57.7)minutes in the APOT group and (235.0±80.2)minutes in the routine surgery group,and the difference was statistically significant ( t=-3.800, P<0.01). The APOT group also experienced less intraoperative blood loss(650(588)ml vs. 800(600)ml; U=1 026.500, P=0.021). No significant differences were found between the groups in combined vein resection and reconstruction,celiac trunk resection,early postoperative complications, readmission rates at 30 days,and postoperative length of stay(all P>0.05). Extra-arterial dissection was performed in all patients,with arterial resection and reconstruction in 3 cases: 2 cases in the APOT group(1 case involving the superior mesenteric artery and 1 case involving the common hepatic artery) and 1 case in the routine group(involving the common hepatic artery). Postoperative abdominal bleeding occurred in 4 cases,with 3 cases in the routine group,1 case in the routine group. The R0 resection rate was 85.7%(24/28)in the APOT group and 80.4%(45/56) in the routine group,without significant differences between the groups( P=0.763). The median overall survival time was 27.6 months for the APOT group and 22.5 months for the routine group,while the median disease-free survival was 11.7 months and 16.8 months,respectively,with no significant differences between the groups( P=0.532, P=0.927). Conclusion:The arterial pre-occlusion technique can be used for extra-arterial dissection in patients with locally advanced pancreatic cancer involving the arteries,reducing surgery time and intraoperative blood loss.