腹腔镜和开腹胆囊癌根治性切除术近期疗效及远期预后的比较  

Analysis for the short-term efficacy and long-term prognosis of laparoscopic and laparotomy radical resection for gallbladder cancer

作　　者：窦常伟 张春旭 刘杰[1] 成剑[1] 金丽明 刘军伟[1] 张成武[1] Changwei Dou;Chunxu Zhang;Jie Liu;Jian Cheng;Liming Jin;Junwei Liu;Chengwu Zhang(Department of Hepatopancreatobiliary Surgery&Minimally Invasive Surgery,Zhejiang Provincial People′s Hospital(People′s Hospital of Hangzhou Medical College),Hangzhou 310004,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)肝胆胰外科、微创外科,杭州310004

出　　处：《中华外科杂志》2022年第2期140-147,共8页Chinese Journal of Surgery

基　　金：国家自然科学基金(81902359);浙江省医药卫生科技项目(2020KY044,2021KY045);浙江省中医药科技项目(2020ZA014);浙江省基础公益研究计划项目(LGF20H030011,LY21H160050)。

摘　　要：目的比较腹腔镜和开腹胆囊癌根治术的近期临床疗效及远期预后。方法回顾性分析2010年1月至2020年12月于浙江省人民医院肝胆胰外科接受胆囊癌根治术的133例胆囊癌患者的临床及术后随访资料。其中80例完成腹腔镜胆囊癌根治术(腹腔镜组),男性23例,女性57例,年龄[M(IQR)]66.0(12.8)岁(范围:28.0~82.0岁);53例完成开腹胆囊癌根治术(开腹组),男性8例,女性45例,年龄63.0(6.0)岁(范围:45.0~80.0岁)。腹腔镜组与开腹组在年龄、性别、体重指数、术前白蛋白、术前总胆红素、N分期、脉管侵犯、神经侵犯及肿瘤分化的差异均无统计学意义(P值均>0.05),而术前CA19-9(Z=-2.955,P=0.003)、术前ALT水平(Z=-2.801,P=0.031)、T分期分布(χ^(2)=19.110,P=0.007)的差异均有统计学意义。定量资料的比较采用非参数检验,分类资料的比较采用χ^(2)检验或Fisher确切概率法。结果两组患者在手术时间、淋巴结清扫数目、阳性淋巴结数目、术中胆囊破裂,术后胆瘘、腹腔出血、腹腔感染发生率,术后30 d和90 d病死率、切口种植及术后腹腔转移方面的差异均无统计学意义(P值均>0.05);腹腔镜组术中出血量[100.0(200.0)ml比400.0(250.0)ml](Z=-5.260,P<0.01)、引流管留置时间[6.0(3.8)d比7.0(4.0)d](Z=-3.351,P=0.001)及术后住院时间[8.0(5.0)d比14.0(7.5)d](Z=-6.079,P<0.01)优于开腹组。腹腔镜组1、3年总体生存率分别为63.6%、49.6%,开腹组1、3年总体生存率分别为37.7%、12.9%,差异有统计学意义(P<0.01);腹腔镜组1、3年无进展生存率分别为79.4%、54.1%,开腹组1、3年无进展生存率分别为55.7%、37.6%,差异有统计学意义(P<0.01)。对T1b~T2期及T3期胆囊癌进行亚组分析,结果显示,两组术后总体生存率及无进展生存率的差异均无统计学意义(P值均>0.05)。结论腹腔镜胆囊癌根治术可取得与开腹手术类似的近期临床结局和长期预后,且具有手术创伤小及术后恢复快的优势。Objective To compare the short-term efficacy and long-term prognosis of laparoscopic and laparotomy radical resection for gallbladder cancer(GBC).Methods From January 2010 to December 2020,the clinical data and survival information for 133 patients who underwent radical resection of GBC at the Department of Hepatopancreatobiliary Surgery,Zhejiang Provincial People′s Hospital,were retrospectively collected.Eighty patients(23 males and 57 females)underwent laparoscopic radical resection and had a median age(M(IQR))of 66.0(12.8)years(range:28.0 to 82.0 years).Fifty-three patients(45 males and 8 females)who received laparotomy were 63.0(6.0)years old(range:45.0 to 80.0 years old).There were no significant differences in age,gender,body mass index,preoperative albumin,preoperative total bilirubin,N stages,vascular invasion,peri-neural invasion or tumor differentiation between the laparoscopic and laparotomy group(all P>0.05).But there were significant differences in preoperative CA19-9(Z=-2.955,P=0.003),preoperative ALT level(Z=-2.801,P=0.031)and T stage(χ^(2)=19.110,P=0.007)between the two groups.A non-parametric test was used for quantitative data.χ^(2) test or Fisher exact probability method was used for count data.Results Patients in the laparoscopic group did not differ from those in the laparotomy group in terms of length of operation,number of lymph node yield,number of positive lymph nodes,the incidence of intraoperative gallbladder rupture,incidence of postoperative bile leakage,abdominal bleeding or abdominal infection,30-day mortality,90-day mortality,the incidence of incision implantation or peritoneal cavity metastasis(all P>0.05).Patients in the laparoscopic group showed less intraoperative bleeding(100.0(200.0)ml vs.400.0(250.0)ml)(Z=-5.260,P<0.01),fewer days with drainage tube indwelling(6.0(3.8)days vs.7.0(4.0)days)(Z=-3.351,P=0.001),and fewer postoperative days in hospital(8.0(5.0)days vs.14.0(7.5)days)(Z=-6.079,P<0.01)than those in the laparotomy group.Patients in the laparoscopic group displaye

关 键 词：胆囊肿瘤 外科手术 近期疗效 远期预后 

分 类 号：R735.8[医药卫生—肿瘤]