鞘外解剖肝蒂技术治疗肝内胆管细胞癌的疗效评估  

Evaluation of Therapeutic Effect of Glissonean Pedicle Transection Technique in The Treatment of IntrahepaticCholangiocarcinoma

作　　者：刘炯 彭乐[1] 马伟 江斌 Liu Jiong;PengLe;MaWei;Jiang Bin(Hepatobiliary Pancreatic Surgery Diagnosis and Treatment Center of Taihe Hospital Affiliated to Shiyan City,Hubei Medical University,Shiyan Hubei Province 444200,China)

机构地区：[1]湖北医药学院附属十堰市太和医院肝胆胰外科诊疗中心,湖北十堰442000

出　　处：《中华普外科手术学杂志（电子版）》2024年第4期373-376,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：湖北省陈孝平科技发展基金项目(CXPJJH11800001-2018246)。

摘　　要：目的探讨鞘外解剖肝蒂技术在腹腔镜肝切除术中治疗肝内胆管细胞癌(ICC)患者的疗效及对患者肝功能和炎症反应的影响。方法去收集并分析2018年1月1日至2019年12月31日于我院接受鞘外解剖肝蒂技术治疗肝内胆管细胞癌的116例患者临床资料,根据手术方式分鞘外组(n=58)及鞘内组(n=58),对所有患者进行为期3年的随访。比较两组患者手术时间、术中失血量、肛门首次排气时间、术后住院日、术前和术后1d、3d、7d的肝功能指标(ALT、AST、TBIL、ALB)炎性因子(CRP、IL-6、TNF-α)并发症情况、随访期间的生存情况等。采用SPSS22.0软件分析数据。计量资料组间比较采用t检验,计数资料组间比较采用X检验,生存分析采用Log-Rank检验。P<0.05表示差异有统计学意义。结果鞘外组手术时间、术中失血量、肛门首次排气时间和术后住院日均显著低于鞘内组(P<0.05)。鞘外组患者术后1d、3d、7d的ALT、AST、TBIL水平均显著低于鞘内组(P<0.05),而ALB水平则显著高于鞘内组(P<0.05)。鞘外组患者术后1d、3d、7d的CRP、IL-6、TNF-α水平均显著低于鞘内组(P<0.05)。鞘外组患者术后1年生存率和3年生存率均显著高于鞘内组(P<0.05)。结论鞘外解部肝蒂技术在腹腔镜肝切除术中治疗ICC患者具有手术创伤小、出血少、恢复快等优点,能有效保护患者的肝功能,减轻炎症反应,不影响生存质量,值得临床推广应用.Objective To investigate the efficacy of extrinsic anatomic liver pedicle technique in the treatment of intrahepatic cholangiocarcinoma(ICC)patients during laparoscopic hepatectomy and its influence on liver function and inflammation.Methods Clinical data of 116 patients who received extrinsic anatomic pedicle technique for intrahepatic cholangiocarcinoma in our hospital from January 1,2018 to December 31,2019 were collected and analyzed.They were divided into extrinsic group(n=58)and intrathecal group(n=58)according to the surgical method,and all patients were followed up for 3 years.The operation duration,intraoperative blood loss fist anal exhaust time,postoperative hospital stay,liver function indexes(ALT,AST,TBIL,ALB),inflammatory factors(CRP,IL-6,TNF-α),complications,and survival during follow-up were compared between the two groups.SPSS 22.0 software was used to analyze the data.The t test was used for inter-group comparison,the X test was used for inter-group comparison and the Log-Rank test was used for survival analysis.P<0.05 indicated that the difference was statistically significant.Results sThe operative time,intraoperative blood loss,first anal exhaust time and postoperative hospitalization day in extrinsic group were significantly lower than those in intraoral group(P<0.05),The ALT,AST and TBIL levels in extrasthecal group were significantly lower than those in intrathecal group(P<0.05)at 1,3 and 7 days after surgery,while the ALB level was significantly higher than that in intrathecal group(P<0.05).The levels of CRP,IL-6 and TNF-αin extrinsic group were significantly lower than those in intrathecal group at 1d,3d and 7d affer surgery(P<0.05).The 1-year survival rate and 3-year survival rate in extrinsic group were significantly higher than those in intrathecal group(P<0.05).Conclusion In the treatment of ICC patients during laparoscopic hepatectomy,extrinsic anatomical liver stell technique has the advantages of less surgical trauma,less bleeding and faster recovery,which can effectively protec

关 键 词：肝内胆管细胞癌 鞘外解部肝蒂技术 腹腔镜肝切除术 肝功能 炎症反应 

分 类 号：R735.8[医药卫生—肿瘤]