全腹腔镜与开腹Bismuth-Ⅲb型肝门胆管癌根治术的临床研究

A case matched study on laparoscopic versus open radical resection for Bismuth-type Ⅲb hilar cholangiocarcinoma

目的探讨全腹腔镜Bismuth-Ⅲb型肝门胆管癌根治术的安全性及可行性。方法回顾性分析2015年1月至2018年2月沧州市中心医院109例Bismuth-Ⅲb型肝门胆管癌根治术患者的临床资料,将接受腔镜手术的17例患者设为实验组,筛选同时期相匹配的17例开腹手术患者设为对照组,将两组各项临床数据进行对比分析。结果实验组与对照组在手术时间[(420.8±136.5)min比(292.3±65.6)min]、手术切口总长度[(8.2±4.7)cm比(20.4±5.8)cm]、术后并发症发生率[29.4%(5/17)比52.9%(9/17)]、术后进流食时间、术后ICU入住时间、术后住院时间等比较,差异均有统计学意义(均P<0.05)。术中出血量[(325.2±98.7)ml比(367.4±72.9)ml]、病理结果、淋巴结清扫数目、RO切除率、肿瘤复发率等比较,差异无统计学意义(均P>0.05)。结论全腹腔镜Bismuth-IDE型肝门胆管癌根治术安全、可行,且具有创伤小、恢复快等优势。

Objective To explore the safety and feasibility of laparoscopic radical resection of Bismuth-type Ⅲb hilar cholangiocarcinoma.Methods The clinical data of 109 patients with Bismuth-type ID b hilar cholangiocarcinoma in the Department of General Surgery of Cangzhou Central Hospital from Jan 2015 to Feb 2018 were retrospectively analyzed.Among those 17 patients undergoing total laparoscopic surgery were compared with 17 open cases.Results There were significant differences between the laparoscopic group and the control group in operation lime[(420.8±136.5 ) min vs (292.3±65.6) min ], total length of incision [(8.2±4.7 ) cm vs (20.4±5.8 ) cm ], incidence of postoperative complications [29.4%(5/17) vs 52.9%(9/17 )], postoperative feeding time, postoperative ICU stay and postoperative hospital stay (P<0.05 ).There were no significant difference in the amount of bleeding[(325.2±98.7) ml vs(367.4±72.9) ml], pathological results, number of lymph node dissection, R0 resection rate and tumor recurrence rate (P>0.05 ).Conclusion Total laparoscopic radical resection of Bismuth- type ID b hilar cholangiocarcinoma is safe, feasible, and has the advantages of minimal invasion and rapid recovery.