腹腔镜胆囊癌根治术在治疗Ⅲ期胆囊癌中的应用  

Application of laparoscopic radical cholecystectomy in the treatment of stageⅢgallbladder cancer

作　　者：史佳宇 姜雪薇 丹增阿旺 刘赋斌 何正为 吴成宪 蓝润虎 袁宵寅 王益[1] 王超 张斌豪 Shi Jiayu;Jiang Xuewei;Danzeng Awang;Liu Fubin;He Zhengwei;Wu Chengxian;Lan Runhu;Yuan Xiaoyin;Wang Yi;Wang Chao;Zhang Binhao(Department of Hepatobiliary Surgery,Tongji Tianyou Hospital Affiliated to Wuhan University of Science and Technology,Wuhan 430064,China;Hepatic Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]武汉科技大学附属同济天佑医院肝胆外科,武汉430064 [2]华中科技大学同济医学院附属同济医院肝脏外科中心,武汉430030

出　　处：《中华肝胆外科杂志》2023年第2期108-113,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：华中科技大学教学研究项目(2019131);华中科技大学思政专项研究项目(20211132);华中科技大学研究生教改面上项目(MS046)。

摘　　要：目的研究腹腔镜胆囊癌根治术在治疗美国癌症联合委员会(AJCC) TNM Ⅲ期胆囊癌患者中的价值。方法回顾性分析了2015年5月至2022年5月在华中科技大学同济医学院附属同济医院肝脏外科中心行胆囊癌根治术且术后病检证实为AJCC TNM Ⅲ期184例胆囊癌患者的临床病例资料以及术后随访资料,其中男性66例,女性118例,年龄(67.0±8.6)岁,年龄范围38~85岁。根据手术方式的不同分为两组:行腹腔镜胆囊癌根治术的患者为腹腔镜组(n=71例),行开腹胆囊癌根治术的患者为开腹组(n=113)。对比两组患者的一般病例资料、并发症情况及预后。利用门诊复查及电话回访的形式随访。结果与开腹组相比,腹腔镜组患者术后丙氨酸氨基转移酶[67.5(40.0,138.5)比104.0(45.0,252.2)U/L]、天冬氨酸氨基转移酶[41.5(26.0,71.2)比53.0(30.2,153.5)U/L]、引流管留置时间[8.00(6.00,10.25)比10.00(6.00,13.00)d]、术后住院天数[10.00(8.00,15.25)比14.00(9.00,19.00)d]均降低,而白蛋白水平增高[32.05(30.18,35.20)比30.50(27.70,33.50)g/L],差异有统计学意义(均P<0.05)。腹腔镜组患者术后并发症总发生率14.1%(10/71)低于开腹组的31.9%(36/113),差异有统计学意义(χ^(2)=5.02,P=0.025)。腹腔镜组患者术后1、2、3年的累积生存率分别为49.1%、24.0%和16.0%,开腹组患者术后1、2、3年的累积生存率分别为61.0%、28.5%和14.5%,两组比较,差异无统计学意义(P=0.640)。腹腔镜组和开腹患者术后3年的无进展生存率分别为18.3%和15.0%,两组比较,差异无统计学意义(P=0.463)。结论腹腔镜胆囊癌根治术与开腹胆囊癌根治术应用于AJCC TNM Ⅲ期胆囊癌患者的疗效相近。相较于开腹胆囊癌根治术,腹腔镜胆囊癌根治术更有助于患者术后恢复。Objective To study the clinical efficacy of laparoscopic radical cholecystectomy in the treatment of stageⅢgallbladder cancer.Methods The clinical characteristics and postoperative follow-up data of 184 patients(male 66,and female 118)who underwent radical cholecystectomy for stageⅢgallbladder cancer at Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,from May 2015 to May 2022,were retrospectively analyzed.The age was(67.0±8.6)years old(range 38 to 85 years old).There were 71 patients in the laparoscopic group and 113 in the open group.The general medical data,surgery-related indicators and complications were analyzed.Follow-up was completed by outpatient visits and by telephone.Results The laparoscopic group showed better postoperative alanine aminotransferase[67.5(40.0,138.5)vs.104.0(45.0,252.2)U/L]and aspartate aminotransferase[41.5(26.0,71.2)vs.53.0(30.2,153.5)U/L]recovery,higher albumin levels[32.05(30.18,35.20)vs.30.50(27.70,33.50)g/L],earlier abdominal drainage tube removal[8.00(6.00,10.25)vs.10.00(6.00,13.00)d],shorter hospital stay[10.00(8.00,15.25)vs.14.00(9.00,19.00)d]and lower incidences of complications[(14.1%(10/71)vs.31.9%(36/113)]when compared with the open group(all P<0.05).The 1 year(49.1%vs 61.0%),2 years(24.0%vs.28.5%),3 years(16.0%vs.14.5%)overall survival(P=0.640),and the 3 years progression-free survival(18.3%vs.15.0%,P=0.463)showed no significant difference between the 2 groups.Conclusion Laparoscopic surgery for AJCC TNM stageⅢgallbladder cancer showed comparable results with open surgery.When compared with open surgery,laparoscopic radical resection of gallbladder cancer had the advantages of earlier removal of abdominal drainage tube,lower incidence of postoperative complications,and shorter hospital stay.

关 键 词：胆囊肿瘤 腹腔镜检查 开腹手术 预后 

分 类 号：R735.8[医药卫生—肿瘤]