胆囊癌仅行腹腔镜胆囊切除术的长期疗效观察  

Long-term efficacy of laparoscopic cholecystectomy for gallbladder cancer

作　　者：吴昕[1] 洪涛[1] 李秉璐[1] 郑朝纪[1] 刘卫[1] 何小东[1] WU Xin;HONG Tao;LI Binglu;ZHENG Chaoji;LIU Wei;HE Xiaodong(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,P.R.China)

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100730

出　　处：《中国普外基础与临床杂志》2020年第6期714-717,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的观察胆囊癌患者仅行腹腔镜胆囊切除术(LC)后的长期疗效。方法回顾性分析北京协和医院基本外科1998年1月至2018年12月期间收治且符合纳入标准的52例仅行了LC的胆囊癌患者的临床病理资料。结果本研究共纳入52例患者,其中男23例,女29例,年龄(67±12)岁。52例患者均因胆囊占位、胆囊结石等原因行LC治疗。有23例患者为术后意外胆囊癌,有29例患者术前或术中即诊断为胆囊癌。11例T1a期术后意外胆囊癌患者接受密切随诊,其余41例患者因高龄、基础疾病重、自身意愿等原因拒绝行根治性手术。52例患者的LC均顺利完成。术后5例患者发生了Clavien-DindoⅠ级并发症。52例患者随访(40.2±33.8)个月,随访期内有31例患者死亡,有21例仍存活;相较于存活患者,死亡患者的年龄更大、住院时间更长、肿瘤分期更晚(P<0.050),T1a期患者的生存期要显著优于T1b及以上分期患者(113.5个月比39.6个月,P<0.001)。结论LC在T1a期胆囊癌患者中可达到根治效果,同时因LC手术操作安全、术后并发症少,还可使部分特殊患者达到追求术后生活质量的要求。Objective To investigate the long-term efficacy of laparoscopic cholecystectomy(LC)for gallbladder cancer.Method The clinical data of 52 patients with gallbladder cancer only underwent LC from January 1998 to December 2018 in the Peking Union Medical College Hospital were analyzed retrospectively.Results Fifty-two patients met the inclusion criteria were included,including 23 males and 29 females.The age was(67±12)years.Fifty-two patients were treated with LC because of gallbladder occupying or gallstone.Twenty-three patients were diagnosed as incidental gallbladder cancer after the surgery,while 29 patients were diagnosed as the gallbladder cancer before or during the operation.Eleven patients with T1a lesions received the close follow-up,the other 41 patients refused the radical operation due to the advanced age,severe underlying diseases or their own preferences.Five cases of postoperative complications were observed.All patients were followed-up for(40.2±33.8)months,21 patients survived and 31 died.The dead patients had an older age,longer hospital stays,and later T stage(P<0.050)as compared with the living patients.The patients with T1a lesions had significantly longer survival time than those with T1b and above(113.5 months versus 39.6 months,P<0.001).Conclusions LC is a radical operation in T1a lesions.At the same time,it can meet the requirements of postoperative life quality for some special patients due to its safety and low postoperative complication rate.

关 键 词：胆囊癌 腹腔镜胆囊切除术 T1a期 预后 

分 类 号：R735.8[医药卫生—肿瘤]