顺逆结合围肝门外科入路手术对侵犯肝门胆囊癌患者切除效果及并发症的影响

Effect of Anterograde and Retrograde Combined Perihilar Surgical Approach on Resection and Complications of Patients with Hilar Invasion of Gallbladder Carcinoma

目的探讨顺逆结合围肝门外科入路手术对侵犯肝门胆囊癌患者切除效果及并发症的影响.方法回顾性分析2019年6月—2021年6月我院收治的84例侵犯肝门胆囊癌患者的临床资料,按照不同手术入路方式分为两组,每组42例.对照组行传统入路手术,观察组行顺逆结合围肝门外科入路手术,术后均持续随访1年.对比两组的术中出血量、切除效果、术后并发症发生率及肿瘤标志物水平.结果观察组术中出血量为(362.55±78.90)mL,少于对照组的(479.05±88.33)mL,差异有统计学意义(P<0.05).观察组的切除效果优于对照组,且R0切除率为71.43%,高于对照组的40.48%,差异有统计学意义(P<0.05).观察组的并发症发生率为12.90%,低于对照组的30.95%,差异有统计学意义(P<0.05).术后7 d,观察组的癌胚抗原、糖类抗原125水平均低于对照组,组间差异有统计学意义(P<0.05).结论顺逆结合围肝门外科入路手术能增强侵犯肝门胆囊癌患者的切除效果,减少术中出血量及并发症,降低肿瘤标志物水平,值得临床推广使用.

Objective To investigate the effect of anterograde and retrograde combined perihilar surgical approach on resection and complications of gallbladder carcinoma with hilar invasion.Methods The clinical data of 84 patients with hilar invasion gallbladder carcinoma admitted to our hospital from June 2019 to June 2021 were retrospectively analyzed.They were divided into two groups according to different surgical approaches,with 42 cases in each group.The control group underwent traditional approach surgery,and the observation group underwent anterograde and retrograde combined perihilar surgical approach surgery.All patients were followed up for 1 year after operation.The intraoperative blood loss,resection effect,postoperative complication rate and tumor marker level were compared between the two groups.Results The intraoperative blood loss in the observation group was(362.55±78.90)mL,which was less than(479.05±88.33)mL in the control group,and the difference was statistically significant(P<0.05).The resection effect of the observation group was better than that of the control group,and the R0 resection rate was 71.43%,which was higher than 40.48%of the control group,and the difference was statistically significant(P<0.05).The complication rate of the observation group was 12.90%,which was lower than 30.95%of the control group,and the difference was statistically significant(P<0.05).On postoperative day 7,the levels of carcinoembryonic antigen and carbohydrate antigen 125 in the observation group were lower than those in the control group,and the differences between the groups were statistically significant(P<0.05).Conclusion The anterograde and retrograde combined perihilar surgical approach can enhance the resection effect of patients with hilar invasion gallbladder cancer,reduce intraoperative blood loss and complications,and reduce the level of tumor markers,which is worthy of clinical application.