不同手术方式对T_(1b)期胆囊癌患者的治疗效果  

Therapeutic effect of different surgical methods in stage T effect of different surgical methods in stage T_(1b) gallbladder carcinoma

作　　者：厉冰[1] 刘赟[1] 孙万日[1] LI Bing;LIU Yun;SUN Wanri(Department of General Surgery,Nanyang Central Hospital,Nanyang 473000,He’nan,China)

机构地区：[1]南阳市中心医院普外科,河南南阳4730000

出　　处：《癌症进展》2023年第11期1231-1233,1276,共4页Oncology Progress

摘　　要：目的探讨不同手术方式对T_(1b)期胆囊癌患者的治疗效果。方法根据手术方式的不同将64例T_(1b)期胆囊癌患者分为对照组(n=32)和观察组(n=32),对照组患者采取腹腔镜下胆囊切除术,观察组患者采取腹腔镜下胆囊切除+胆囊床2 cm楔形切除+区域淋巴结清扫术。比较两组患者的手术相关指标、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]水平、凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)]、并发症发生率及5年随访结果。结果两组患者的术中出血量、术后排气时间、术后胃肠功能恢复时间、术后住院时间比较,差异均无统计学意义(P>0.05)。术后,两组患者的血清IL-6、TNF-α、CRP水平均高于本组术前,PT、APTT、TT均长于本组术前,差异均有统计学意义(P<0.05)。术后,两组患者的血清IL-6、TNF-α、CRP水平及PT、APTT、TT比较,差异均无统计学意义(P>0.05)。两组患者腹腔出血、胆漏、切口感染或腹腔感染发生率比较,差异均无统计学意义(P>0.05)。随访5年,观察组患者的生存率高于对照组(P<0.05);两组患者的肿瘤复发转移率比较,差异无统计学意义(P>0.05)。结论腹腔镜下胆囊扩大切除+区域淋巴结清扫术治疗T_(1b)期胆囊癌可提高患者的5年生存率,不会加重患者的炎症反应,也不会增加并发症发生率。Objective To investigate the therapeutic effect of different surgical methods in stage T1b gallbladder carci-noma.Method A total of 64 patients with stage T1b gallbladder carcinoma were divided into the control group(n=32,re-ceived laparoscopic cholecystectomy)and observation group(n=32,received laparoscopic cholecystectomy+2 cm wedge resection of gallbladder bed+regional lymph node dissection)according to different surgical methods.The operation relat-ed indicators,inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)],coagulation indicators[prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)],in-cidence of complications and outcome of 5-year follow-up were compared between the two groups.Result There were no significant differences in intraoperative blood loss,postoperative exhaust time,postoperative gastrointestinal function recovery time and hospital stay between the two groups(P>0.05).There were no significant differences for IL-6,TNF-α,CRP,PT,APTT and TT before and after surgery in the two groups(P>0.05).After surgery,the IL-6,TNF-αand CRP in the two groups were higher,and PT,APTT and TT were longer than those before surgery(P<0.05).After surgery,there were no significant differences in serum IL-6,TNF-α,CRP levels,PT,APTT and TT between the two groups(P>0.05).There were no significant differences in the incidence of abdominal bleeding,biliary leakage,incision infection and ab-dominal infection between the two groups(P>0.05).Followed up for 5 years,the survival rate of the observation group was higher than that of the control group(P<0.05),but there was no significance difference for the recurrence and metas-tasis rate of tumor between the two groups(P>0.05).Conclusion For patients with stage T1b gallbladder carcinoma,lapa-roscopic gallbladder enlargement resection+regional lymph node dissection can improve the 5-year survival rate without increasing incidence of inflammatory response and complications.

关 键 词：胆囊癌 腹腔镜下胆囊切除术 炎症因子 凝血指标 胆囊扩大切除 

分 类 号：R735.8[医药卫生—肿瘤]