早期ICC腹腔镜肝切除术不同淋巴结清扫范围的近远期效果对比研究  

A comparative study of the near and long term effects of early ICC laparoscopic hepatectomy in different lymph node dissection ranges

作　　者：张金华 赵锁 Zhang Jinhua;Zhao Suo(Department of Hepatobiliary,Breast and Breast Surgery,97th Hospital of the Joint Logistic Support Force,Yantai Shandong Province 264000,China)

机构地区：[1]联勤保障部队第九七〇医院肝胆甲乳外科,山东烟台264000

出　　处：《中华普外科手术学杂志（电子版）》2024年第5期578-581,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的:对比分析早期ICC(肝内胆管细胞癌)腹腔镜肝切除术(LH)不同淋巴结清扫(LND)范围的近远期效果。方法:选取于2020年1月至2022年12月于我院行LH的76例早期ICC患者为研究对象,并将患者以随机数字表法分为标准LND组和局部LND组,每组各38例。两组均行LH,标准LND组:采取标准化的LND,局部LND组:则采取局部LND。数据分析应用SPSS 25.0完成,差异有统计学意义用P<0.05表示。手术相关指标等计量资料以(x±s)表示,采用独立样本t检验;术后并发症等计数资料以[例(%)]表示,采用χ^(2)检验;采用Kaplan-Meier法绘制生存曲线并计算生存率,生存分析采用Log-Rank检验。结果:局部LND组患者手术时间、出血量及LND枚数较标准LND组均显著降低(P<0.05),而两组患者在阳性LND枚数、术后首次排气时间、术后引流管留置时间及术后住院时间上比较差异均无显著性(P>0.05)。局部LND组患者术后并发症总发生率(10.5%)与标准LND组(18.4%)对比,差异无统计学意义(P>0.05)。随访期间,通过Kaplan-Meier生存分析显示,标准LND组和局部LND组患者累积无病生存率(78.9%vs.73.7%)及累积总生存率(84.2%vs.78.9%)比较,差异均无统计学意义(Log-Rankχ^(2)=0.158、0.039,P=0.691、0.843)。结论:与标准化LND相比,早期ICC患者在LH中行局部LND虽缩小了清扫范围,减少了LND枚数,但阳性LND枚数未见显著差异,并可有效缩短手术时间,减少术中损伤,且达到了与标准化LND相当的远期疗效。Objective:To compare and analyze the near and long term effects of laparoscopic hepatectomy(LH)for early ICC(intrahepatic cholangiocarcinoma)in different lymph node dissection(LND)ranges.Methods:Seventy-six patients with early ICC who received LH in our hospital from January 2020 to December 2022 were selected as the study objects,and the patients were divided into standard LND group and local LND group by random number table method,with 38 cases in each group.LH was administered to both groups.Standard LND group:standardized LND was administered,and local LND group:local LND was administered.Data analysis was completed by SPSS 25.0,and the difference was statistically significant as P<0.05.Measurement data such as surgery-related indicators were expressed as(x±s),and independent t test was used;The statistical data of postoperative complications were expressed as[cases(%)]andχ^(2) test was used.Kaplan-Meier method was used to draw the survival curve and calculate the survival rate,and Log-Rank test was used for survival analysis.Results:The operation duration,blood loss and number of LND in local LND group were significantly reduced compared with standard LND group(P<0.05),but there were no significant differences in the number of positive LND,first postoperative exhaust time,postoperative drainage tube indwelling time and postoperative hospital stay between the two groups(P>0.05).There was no significant difference in the total incidence of postoperative complications between local LND group(10.5%)and standard LND group(18.4%)(P>0.05).During follow-up,Kaplan-Meier survival analysis showed that cumulative disease-free survival(78.9%vs.73.7%)and cumulative overall survival(84.2%vs.78.9%)of patients in the standard LND group and the local LND group were compared.There was no significant difference(Log-Rankχ^(2)=0.158,0.039,P=0.691,0.843).Conclusion:Compared with standardized LND,although local LND in LH for early ICC patients can narrow the cleaning range and reduce the number of LND,there is no significant dif

关 键 词：肝内胆管细胞癌 腹腔镜肝切除术 淋巴结清扫 

分 类 号：R657.3[医药卫生—外科学]