胆囊切除术后意外胆囊癌患者再次行腹腔镜胆囊癌根治术的疗效分析  

Analysis of the efficacy of laparoscopic radical surgery for incidental gallbladder cancer following cholecystectomy

作　　者：陈天宇 刘子瑜 尹梦秋 陈曦 付瑞标 王重钰 李军 朱锦辉 Chen Tianyu;Liu Ziyu;Yin Mengqiu;Chen Xi;Fu Ruibiao;Wang Chongyu;Li Jun;Zhu Jinhui(Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学附属第二医院肝胆胰外科,杭州310000

出　　处：《中华肝胆外科杂志》2024年第6期412-416,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：浙江省重点研发计划(2019C03SA801725)。

摘　　要：目的:分析胆囊切除术后意外胆囊癌患者再次行腹腔镜胆囊癌根治术的疗效,并与开腹胆囊癌根治术进行比较。方法:回顾性分析2010年4月至2018年2月浙江大学附属第二医院收治的106例意外胆囊癌患者的临床资料,其中男性66例,女性40例,年龄(64.7±7.9)岁。依据手术方式将患者分为两组:接受腹腔镜胆囊癌根治术的患者纳入腹腔镜组( n=45);接受开腹胆囊癌根治术的患者纳入开放组( n=61)。记录患者的术中出血量、术后住院时间、术后并发症等临床资料。以门诊复查和电话的方式进行随访。采用Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。 结果:45例腹腔镜组患者均顺利完成手术,无中转开腹的患者。与开放组相比,腹腔镜组患者的术中出血量[(100±25) ml比(200±46) ml]和术后住院时间[3(2,5)d比5(4,7)d]均减少,差异均具有统计学意义(均 P<0.05)。腹腔镜组和开放组术后并发症发生率分别为6.7%(3/45)和13.1%(8/61),两组比较,差异有统计学意义( χ2=4.16, P=0.041)。腹腔镜组意外胆囊癌患者胆囊癌根治术后的累积生存率优于开放组( χ2=4.58, P=0.032)。 结论:与开腹胆囊癌根治术相比,胆囊切除术后意外胆囊癌患者再次行腹腔镜胆囊癌根治术在术中出血量、术后住院时间、并发症发生率和生存时间方面均有优势。Objective To analyze the efficacy of laparoscopic radical surgery,compared to open surgery,for incidental gallbladder cancer following cholecystectomy.Methods Clinical data of 106 patients with incidental gallbladder cancer treated at the Second Affiliated Hospital Zhejiang University School of Medicine from April 2010 to February 2018 were retrospectively analyzed,including 66 males and 40 females,aged(64.7±7.9)years old.According to surgical approach,patients were divided into the laparoscopic group(n=45)and open group(n=61).Perioperative data,including intraoperative blood loss,postoperative hospital stay,and postoperative complications,were compared between the groups.Follow-ups were conducted via outpatient visits or telephone reviews.Survival analysis was performed using the Kaplan-Meier method,and the survival rates were compared using the log-rank test.Results All 45 patients in the laparoscopic group successfully underwent the surgery without conversion to open surgery.Compared to the open group,the laparoscopic group had a reduced intraoperative blood loss[(100±25)ml vs.(200±46)ml]and a shortened postoperative hospital stay[3(2,5)d vs.5(4,7)d](both P<0.05).The postoperative complication rates were 6.7%(3/45)in the laparoscopic group and 13.1%(8/61)in the open group(χ2=4.16,P=0.041).The cumulative survival rate after radical surgery for incidental gallbladder cancer was better in the laparoscopic group(χ2=4.58,P=0.032).Conclusion Compared to open surgery,laparoscopic radical surgery for incidental gallbladder cancer showed benefits in intraoperative blood loss,postoperative hospital stay,complication rates,and cumulative survival.

关 键 词：胆囊肿瘤 腹腔镜胆囊切除术 再手术 5年生存率 

分 类 号：R735.8[医药卫生—肿瘤]