完全腹腔镜胆囊癌根治术的临床疗效  

Clinical effect of totally laparoscopic radical resection for gallbladder cancer

作　　者：徐鋆耀[1] 姜海[1] 喻志敏[1] 闵军[1] 陈亚进[1] 

机构地区：[1]中山大学孙逸仙纪念医院肝胆外科,广州510120

出　　处：《中华消化外科杂志》2016年第4期353-356,共4页Chinese Journal of Digestive Surgery

基　　金：广东省科技计划项目（20138021800101）;中山大学青年教师培育项目（15ykpy20）

摘　　要：目的探讨完全腹腔镜胆囊癌根治术的安全性及可行性。方法采用回顾性横断面描述性研究方法。收集2013年1月至2015年8月中山大学孙逸仙纪念医院收治的30例行完全腹腔镜胆囊癌根治术患者的临床资料。根据患者病情联合行肝段或肝外胆道切除术，行肝外胆道切除术者需行相应胆肠吻合术。根据术后病理学检查结果，选择行术后辅助化疗。观察指标：（1）手术情况：手术方式、手术时间、术中出血量、术中淋巴结清扫数目。（2）术后情况：术后下床活动时间、术后进食时间、术后拔除引流管时间、术后并发症发生情况、术后住院时间。（3）术后病理学检查结果：肿瘤分期、切缘情况。（4）术后辅助治疗情况。（5）随访情况：患者生存及肿瘤复发、转移情况。采用门诊和电话方式进行随访，随访时间截至2015年12月。随访患者生存及肿瘤复发、转移情况。计量资料以平均数（范围）表示。结果（1）30例患者均顺利完成完全腹腔镜胆囊癌根治术，均联合行肝S4b和s5段切除＋Nl区域淋巴结清扫术。其中6例患者肿瘤侵犯肝外胆管致梗阻性黄疸联合行腹腔镜肝外胆道切除＋胆肠Roux-en-Y吻合术。无围术期死亡患者。平均手术时间为238min（178～430min），平均术中出血量为250mL（200～600mL），平均术中淋巴结清扫数目为7枚（4～15枚）。（2）患者均于术后第2天下床活动并恢复饮食。平均术后拔除引流管时间为3d（0～25d）。术后2例患者发生并发症，均经对症处理后痊愈。平均术后住院时间为5d（3～28d）。（3）术后病理学检查：30例患者均为R。切除；病理学分期：ⅠB期12例，Ⅱ期10例，ⅢA期7例，ⅢB期1例。（4）1例ⅢB期（pT3N1M0期）患者于术后行吉西他滨＋顺铂化疗，其余患者术后未行辅助治疗。（5）30例患者术后均获得随访。随访时间为4～32个月Objective To investigate the safety and feasibility of totally laparoscopic radical resection of gallbladder cancer. Methods The retrospective cross-sectional descriptive study was adopted. The clinical data of 30 patients who underwent laparoscopic radical resection of gallbladder cancer at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2013 to August 2015 were collected. The patients received synchronous hepatic segmental or extrabepatic bile duct resection according to the conditions of patients, and choledoehojejunostomy was applied to patients undergoing extrahepatic bile duct resection. The patients accepted postoperative adjuvant chemotherapy according to the results of postoperative pathological examination. Observation indicators included （1） operation situations, including surgical procedures, operation time, volume of intraoperative blood loss and number of lymph node dissected, （2） postoperative situations, including time for out- off-bed activity, time for diet intake, time of drainage tube removal, occurrence of complications and duration of hospital stay, （3） results of postoperative pathological examination, including tumor stage and surgical margin, （4） postoperative adjuvant treatment, （5） follow-up situation including the survival of patients, tumor recurrence and metastasis. The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015. Count data were represented as average （range）. Results All the 30 patients underwent successful laparoscopic radical resection of gallbladder cancer combined with hepatic S4b and S5 resection ＋ lymph node dissection at N1 region. Six patients with obstructive jaundice caused by tumor invaded to extrahepatic bile duct underwent combined laparoscopic extrahepatic bile duct resection ＋ Roux-en-Y hepatieojejunostomy, without perioperative death. The average operation time, average volume of intraoperati

关 键 词：胆囊肿瘤 根治性切除术 腹腔镜检查 

分 类 号：R735.8[医药卫生—肿瘤]