完全腹腔镜根治术治疗胆囊癌患者安全性及疗效临床分析  

Clinical efficacy and safety of laparoscopic radical cholecystectomy in treatment of patients with gallbladder cancer

作　　者：张德智 刘现立[2] 赵玉鹏 Zhang Dezhi;Liu Xianli;Zhao Yupeng(Department of General Surgery,General Hospital of Coal Group,Yima 472300,Henan Province,China)

机构地区：[1]义马煤业集团股份有限公司总医院普通外科,河南省义马市472300 [2]河南科技大学第一附属医院普通外科

出　　处：《实用肝脏病杂志》2018年第4期529-532,共4页Journal of Practical Hepatology

基　　金：河南省教育厅科研基金资助项目(编号:2012GGJS269)

摘　　要：目的探讨完全腹腔镜胆囊癌根治术(LRC)治疗胆囊癌患者的安全性及疗效。方法 2013年1月~2015年12月我院收治的40例胆囊癌患者,其中19例接受LRC治疗,21例接受开腹胆囊癌根治术。随访2年,采用Kaplan-Meier生存曲线行生存分析。结果 LRC组手术时间、淋巴结清扫数和术中出血量分别为(238.4±31.2)min、(7.5±1.2)个和(210.5±21.1)ml,而开腹组分别为(316.5±11.5)min、(7.8±0.9)个和(301.2±22.8)ml,其中手术时间和出血量显著短于或少于开腹组(P<0.01);下床活动时间、拔管时间、进食时间、肛门排气时间和住院日分别为(2.1±0.5)d、(3.5±2.1)d、(2.5±0.9)d、(1.1±0.1)d和(5.4±2.1)d,均显著短于开腹组【分别为(7.1±1.2)d、(14.5±6.6)d、(3.8±1.8)d、(1.9±0.5)d和(8.2±5.8)d,P<0.01】;LRC组发生切口感染1例,胆漏2例(15.8%),而开腹组发生切口感染4例,胆漏5例(42.9%,x2=4.286,P=0.038);LRC组和开腹组1 a生存率分别为94.7%和95.2%,2 a生存率为78.9%和71.4%,两组总体生存率比较无统计学差异(x2=0.655,P=0.418);术后第13个月和18个月,LRC组各有1例出现腹腔淋巴结转移,术后第14个月、16个月和20个月,开腹组各有1例出现腹腔淋巴结转移。结论LRC治疗胆囊癌患者安全可行,疗效与开放性胆囊癌根治术相同,但手术时间和住院时间更短。Objective To investigate the safety and efficacy of laparoscopic radical cholecystectomy(LRC)in treatment of patients with gallbladder cancer.Methods 40 patients with gallbladder cancer were recruited in our hospital between January 2013 and December 2015,and were randomly divided into two groups.19 received LRC,and 21 received open radical cholecystectomy.All patients were followed-up for two years,and the overall survival was estimated by Kaplan-Meier analysis.Results The operation time,the numbers of lymph nodes cleared and bleeding in the LRC group were(238.4±31.2)min,(7.5±1.2)and(210.5±21.1)ml,while they were[(316.5±11.5)min(P<0.01),(7.8±0.9)and(301.2±22.8)ml(P<0.01),in the open redical cholecystectomy,respectively];the ambulation time,stoping drainage time,eating time,postoperative exhaust time and hospitalization time were(2.1±0.5)d,(3.5±2.1)d,(2.5±0.9)d,(1.1±0.1)d and(5.4±2.1)d,much shorter than in the open redical cholecystectomy[(7.1±1.2)d,(14.5±6.6)d,(3.8±1.8)d,(1.9±0.5)d and(8.2±5.8)d,respectively,P<0.01】;infection and bile leak occurred in one and two patients(15.8%)in LRC group,much lower than four and five(42.9%,x2=4.286,P=0.038)in the open redical cholecystectomy;the 1 year survival rates in LRC and in open redical cholecystectomy group were 94.7%and 95.2%,and 2 year survival rates were 78.9%and 71.4%,respectively in the two groups(x2=0.655,P=0.418);abdominal lymph node metastasis occurred in two patients in LRC group and in three in patients underwent open redical cholecystectomy.Conclusion LRC is safe and feasible for the treatment of patients with gallbladder cancer,and the efficacy is similar to that,but hospitalization time is shorter than that with open radical cholecystectomy.

关 键 词：胆囊癌 腹腔镜 根治性切除术 疗效 

分 类 号：R735.8[医药卫生—肿瘤]