完全腹腔镜手术与开放性手术治疗胆囊癌的临床效果比较

Total laparoscopic surgery vs open surgery in the treatment of gallbladder carcinoma

目的探讨胆囊癌完全腹腔镜手术与开放性手术的治疗效果。方法回顾性分析2012年3月至2016年12月采用腹腔镜手术51例和开放性手术41例行胆囊癌手术的临床资料。比较两组患者手术前后情况及生存率，评价其疗效。结果两组患者一般资料、TNM临床分期和手术方式有可比性。均无围手术期死亡。两组术中出血量、手术时间、术后肛门排气时间和术后住院时间等比较（分别t=2．756，2．325，1．362，2．252，均P〈0．05），差异有统计学意义，腹腔镜组优于开腹组。两组住院总费用比较（t=0．655，P〉0．05），差异无统计学意义。术后近期并发症腹腔镜组少于剖腹组，差异有统计学意义（χ2=5．522，P〈0．05）。术后1、3、5年生存率比较，差异无统计学意义（分别χ^2=0．356，0．428，0．388，均P〉0．05）。结论腹腔镜胆囊癌根治术是安全可行的，较之开腹手术创伤小，术后近期并发症少，恢复速度明显快于开腹手术。

Objective To investigate the therapeutic effect of total laparoscopic vs open surgery for gallbladder carcinoma. Methods Clinical data of 51 cases of laparoscopic surgery and 41 cases of open operation for gallbladder cancer from Mar 2012 to Dec 2016 were analyzed retrospectively. Results There were no perioperative death in both groups. The blood loss during operation, operative time, the first anal exhaust after operation and the hospital stay were in favour of laparoscopic procedure （ t = 2. 756,2. 325, 1. 362,2. 252, P 〈0. 05 ）. There was no significant difference in total hospitalization expenses （ t = 0. 655, P 〉 0. 05 ） , the short-term postoperative complications were in favor for laparoscopic surgery （X^2 = 5. 522, P 〈 0. 05 ）. The 1 , 3, 5 - year survival rates of laparoscopic group and laparotomy group were comparable （X^2 = 0. 356,0. 428,0. 388 ,P 〉 0. 05 ）. Conclusion Laparoscopic radical surgery for gallbladder cancer is safe, feasible and less traumatic than open surgery, with long term survival comparable to open surgery.