可切除肝门部胆管癌术中区域淋巴结清扫与扩大淋巴结清扫的临床疗效  

Clinical efficacy of intraoperative regional lymphadenectomy and extended lymphadenectomy in resectable hilar cholangiocarcinoma

作　　者：魏星博 职意凡 唐昌乾 李济振 朱恒立 郭宇麒 任泳年 李冬筱 李德宇 Wei Xingbo;Zhi Yifan;Tang Changqian;Li Jizhen;Zhu Hengli;Guo Yuqi;Ren Yongnian;Li Dongxiao;Li Deyu(Department of Hepatobiliary and Pancreatic Surgery,Henan University People′s Hospital,Zhengzhou 450003,China;Department of Hepatobiliary and Pancreatic Surgery,Zhengzhou University People′s Hospital,Zhengzhou 450003,China;Department of Gastroenterology,Zhengzhou University People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院肝胆胰腺外科,郑州450003 [2]郑州大学人民医院肝胆胰外科,郑州450003 [3]郑州大学人民医院消化内科,郑州450003

出　　处：《中华消化外科杂志》2025年第2期249-256,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82103617,82103618);河南省科技攻关计划项目(232301420056)。

摘　　要：目的探讨肝门部胆管癌根治术中区域淋巴结清扫与扩大淋巴结清扫的临床疗效。方法采用倾向评分匹配及回顾性队列研究方法。收集2014年1月至2018年1月河南大学人民医院收治的187例肝门部胆管癌患者的临床病理资料;男105例,女82例;年龄为(57±9)岁。187例患者中,62例行肝门部胆管癌根治术+扩大淋巴结清扫,设为扩大组;125例行肝门部胆管癌根治术+区域淋巴结清扫,设为区域组。观察指标:(1)倾向评分匹配情况及匹配后两组患者临床资料比较。(2)术中和术后情况。(3)随访情况。正态分布的计量资料组间比较采用独立样本t检验,偏态分布的计量资料组间比较采用Mann‑Whitney U检验。计数资料组间比较采用χ^(2)检验。等级资料采用秩和检验。采用Kaplan‑Meier法计算生存率并绘制生存曲线,Log‑rank检验进行生存分析。倾向评分匹配按1∶1最近邻匹配法匹配,卡钳值为0.1。结果(1)倾向评分匹配情况及匹配后两组患者临床资料比较。187例患者中,104例匹配成功,扩大组和区域组各52例。倾向评分匹配后消除匹配前肿瘤最大径、神经侵犯、Bismuth分型、TNM分期因素混杂偏倚,具有可比性。(2)术中和术后情况。倾向评分匹配后扩大组患者手术时间为(341±83)min、淋巴结清扫数目为(12.3±4.5)枚、阳性淋巴结清扫数目为(2.2±0.7)枚、术后新发淋巴结肿大为17例;区域组患者上述指标分别为(311±73)min、(9.2±3.4)枚、(1.5±0.5)枚、44例;两组患者上述指标比较,差异均有统计学意义(t=-1.99、-3.92、-5.57,χ^(2)=31.18,P<0.05)。(3)随访情况。倾向评分匹配后104例患者均获得术后随访,随访时间为29(3~49)个月。扩大组和区域组患者术后3年总生存率分别为44.2%和30.8%,两组比较,差异有统计学意义(χ^(2)=4.41,P<0.05)。结论肝门部胆管癌根治术中区域淋巴结清扫与扩大淋巴结清扫的围手术期安全性相当;扩大淋�Objective To investigate the clinical efficacy of intraoperative regional lymphadenectomy and extended lymphadenectomy in resectable hilar cholangiocarcinoma.Methods The propensity score matching and retrospective cohort study was conducted.The clinicopathological data of 187 patients of hilar cholangiocarcinoma who were admitted to Henan University People′s Hospital from January 2014 to January 2018 were collected.There were 105 males and 82 females,aged(57±9)years.Of the 187 patients,62 patients undergoing hilar cholangiocarcinoma resection with extended lymphadenectomy were divided into the extended group,and 125 patients undergoing hilar cholangiocarcinoma resection with regional lymphadenectomy were divided into the regional group.Observation indicators:(1)propensity score matching status and comparison of clinical data of patients between the two groups after matching;(2)intraoperative and postoperative conditions;(3)follow-up.Comparison of measurement data with normal distribu-tion between groups was conducted using the independent sample t test.Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test.Comparison of count data between groups was conducted using the chi-square test.Comparison of ordinal data was conducted using the rank sum test.The Kaplan-Meier method was used to plot calculate survival rate and survival curve.The Log-rank test was used for survival analysis.Propen-sity score matching was performed using the 1∶1 nearest neighbor matching method,with the caliper value of 0.1.Results(1)Propen-sity score matching status and comparison of clinical data of patients between the two groups after matching.Of the 187 patients,104 patients were success-fully matched,with 52 cases in each of the extended group and the regional group.After propensity score matching,the elimination of tumor diameter,neural invasion,Bismuth classification,and TNM staging confounding bias ensured comparability.(2)Intraoperative and postoperative conditions.Aft

关 键 词：胆管肿瘤 肝门部胆管癌 淋巴结清扫 倾向评分匹配 临床疗效 

分 类 号：R73[医药卫生—肿瘤]