腹腔镜与开腹肝切除术治疗肝内胆管细胞癌患者疗效与安全性研究  

Comparison of efficacy and safety of laparoscopic and open liver resection in the treatment of patients with intrahepatic cholangiocarcinoma

作　　者：周建[1] 陆旭[2] 朱岩举 王庆元[1] 冯明明[1] 郭胜利[1] Zhou Jian;Lu Xu;Zhu Yanju(Branch of Biliary Tract Diseases,General Surgery,Central Hospital,Nanyang 473000,Henan Province,China)

机构地区：[1]河南省南阳市中心医院普通外科胆道病区,473000 [2]郑州大学第一附属医院肝胆胰外科

出　　处：《实用肝脏病杂志》2022年第2期275-278,共4页Journal of Practical Hepatology

基　　金：河南省高等学校重点科研项目(编号:20A320037)。

摘　　要：目的比较腹腔镜肝切除术(LLR)与开腹肝切除术(OLR)治疗肝内胆管细胞癌(ICC)患者的疗效与安全性。方法2015年1月~2018年6月我院诊治的ICC患者74例,其中32例接受LLR手术,另42例接受OLR手术。随访3年。结果两组年龄、性别、腹部手术史、血清CA19-9和CEA水平、神经侵犯、微血管侵犯、肿瘤低分化、肿瘤直径和淋巴结肿大等差异无统计学意义(P>0.05);LLR组术中失血量、手术切口长度、肝门阻断、术后住院日、输血和胃肠道功能恢复时间分别为325(250,475)ml、5(3.5,6.5)cm、9例(28.1%)、7(5,12)d、2例(6.2%)和2(2,4)d,与OLR组【分别为500(375,750)ml、20.5(17.0,25.0)cm、31例(73.8%)、10(7,15)d、7例(16.7%)和4(3,6)d】比,差异具有统计学意义(P<0.05),而两组1 a生存率(81.2%对76.2%)和3 a生存率(46.8%对33.3%)无显著性差异(P>0.05);术后,两组均未发生严重并发症。结论在当前情况下,采取OLR或LLR手术治疗ICC患者均可获得较好的治疗效果,且并发症较少。各地可根据肿瘤和全身情况,选择合适的手术方法。Objective The aim of this study was to compare the efficacy and safety of laparoscopic(LLR)and open liver resection(OLR)in the treatment of patients with intrahepatic cholangiocarcinoma(ICC).Methods 74 patients with ICC were enrolled in our hospital between January 2015 and June 2018,and 32 patients received LLR and 42 underwent OLR.All patients in the two groups were followed-up for 3 years.Results There was no significant differences as respect to ages,gender,abdominal operation history,serum carbohydrate antigen 199 and carcinoembryonic antigen levels,nerve invasion,microvascular invasion,tumor low differentiation,tumor diameters and lymph node enlargement between the two groups(P>0.05);the intraoperative blood loss,surgical incision length,hepatic portal occlusion,postoperative hospital stay,percentages of blood transfusion and post-operational gastrointestinal function recovery in patients receiving LLR were 325(250,475)ml,5(3.5,6.5)cm,9 cases(28.1%),7(5,12)d,2 cases(6.2%)and 2(2,4)d,significantly different as compared to[500(375,750)ml,20.5(17.0,25.0)cm,31 cases(73.8%),10(7,15)d,7 cases(16.7%)and 4(3,6)d]in patients receiving OLR(P<0.05),while there were no significant differences in one-year(81.2%vs.76.2%)and three year(46.8%vs.33.3%)survivals between the two groups(P>0.05);no severe untoward effects post-operationally occurred in our series.Conclusion At present,the LLR might be an alternative option for patients with ICC,although the OLR is still underwent in some circumstances,so the surgeon could make choice based on the patients’conditions and the technical requirement.

关 键 词：肝内胆管细胞癌 腹腔镜肝切除术 开腹肝切除术 治疗 生存 

分 类 号：R735.8[医药卫生—肿瘤]