联合全尾状叶与联合部分尾状叶切除的肝门部胆管癌根治术疗效比较  

Efficacy comparison between combining total caudate lobotomy and combining partial caudate lobotomy of hilar cholangiocarcinoma radical resection

作　　者：陈流华[1] 黄锡泰 刘韩笑 赖佳明[1] 梁力建[1] 殷晓煜[1] Chen Liuhua;Huang Xitai;Liu Hanxiao;Lai Jiaming;Liang Lijian;Yin Xiaoyu(Department of Biliary and Pancreatic Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院胆胰外科,广州510080

出　　处：《中华肝脏外科手术学电子杂志》2021年第6期559-563,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省自然科学基金面上项目(2019A1515010686)。

摘　　要：目的比较联合全尾状叶切除与联合部分尾状叶切除的肝门部胆管癌根治术的安全性及远期疗效。方法回顾性分析2014年7月至2018年4月中山大学附属第一医院行联合尾状叶切除的33例肝门部胆管癌根治术患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男23例,女10例;年龄29~77岁,中位年龄60岁。采用倾向得分匹配法(PSM)将患者以1∶1分为全尾状叶切除组及部分尾状叶切除组,比较两组患者的近期及远期疗效。两组并发症发生率比较采用Fisher确切概率法,手术时间比较采用Mann-Whitney U检验。生存分析采用Kaplan-Meier法和Log-rank检验。结果PSM后全尾状叶切除与部分尾状叶切除组各13例。全尾状叶切除组手术时间中位数为390(170)min,明显长于部分尾状叶切除组的300(63)min(Z=2.722,P<0.05)。全尾状叶切除组术后发生并发症8例,部分尾状叶切除组3例,差异无统计学意义(P=0.111)。全尾状叶切除组1、3、5年总体生存率分别为83.1%、44.3%、44.3%,部分尾状叶切除组相应为67.7%、25.4%、25.4%,差异无统计学意义(χ^(2)=0.986,P>0.05)。全尾状叶切除组1、3、5年无复发生存率分别为63.6%、27.3%、27.3%,部分尾状叶切除组相应为57.7%、28.8%、14.4%,差异亦无统计学意义(χ^(2)=0.004,P>0.05)。结论在肝门部胆管癌根治术中,与联合部分尾状叶切除相比,全尾状叶切除增加手术时间,但两者术后并发症发生率及长期生存并无明显差异。Objective To compare the safety and long-term efficacy between combining total caudate lobotomy and combining partial caudate lobotomy of hilar cholangiocarcinoma radical resection.Methods Clinical data of 33 patients with hilar cholangiocarcinoma who underwent radical resection of hilar cholangiocarcinoma combined with caudate lobotomy in the First Affiliated Hospital of Sun Yat-sen University from July 2014 to April 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,23 patients were male and 10 female,aged from 29 to 77 years,with a median age of 60 years.All patients were divided into the total and partial caudate lobotomy groups with a ratio of 1∶1 by propensity score matching(PSM).The short-and long-term clinical efficacy was statistically compared between two groups.The incidence of complications between two groups was compared by Fisher's exact probability test.The operation time was compared by Mann-Whitney U test.Survival analysis was conducted by Kaplan-Meier method and Log-rank test.Results After PSM,13 patients were assigned into the total caudate lobotomy group and 13 cases into the partial caudate lobotomy group.In the total caudate lobotomy group,the median operation time was 390(170)min,significantly longer than 300(63)min in the partial caudate lobotomy group(Z=2.722,P<0.05).In the total caudate lobotomy group,8 patients developed postoperative complications and 3 cases in the partial caudate lobotomy group,and no statistical significance was noted between two groups(P=0.111).In the total caudate lobotomy group,the 1-,3-,5-year overall survival rates were 83.1%,44.3%,44.3%,and 67.7%,25.4%,25.4% correspondingly in the partial caudate lobotomy group,and no statistical significance was observed between two groups(χ^(2)=0.986,P>0.05).In the total caudate lobotomy group,the 1-,3-,5-year recurrence-free survival rates were 63.6%,27.3%,27.3%,and 57.7%,28.8%,14.4% in the partial caudate lobotomy group,

关 键 词：肝门部胆管癌 胆管肿瘤 肝切除术 倾向得分匹配 

分 类 号：R735.8[医药卫生—肿瘤]