腹腔镜胆囊癌根治术治疗仅侵犯胆囊黏膜或黏膜固有层胆囊癌的效果及远期预后研究

Clinical effect and long-term prognosis of laparoscopic radical cholecystectomy for gallbladder carcinoma involving only the mucosa or mucosal lamina propria of gallbladder

目的研究腹腔镜胆囊癌根治术治疗仅侵犯胆囊黏膜或黏膜固有层胆囊癌的效果及远期预后。方法选取2013年1月-2014年6月该院收治的仅侵犯胆囊黏膜或黏膜固有层的胆囊癌患者80例,以随机数字表法将患者分为开腹组(开腹根治术)和腹腔镜组(腹腔镜胆囊癌根治术),每组各40例。比较两组围手术期指标(手术时间、术中出血量、肠鸣音恢复时间、排气时间、排便时间和离床活动时间)、血清指标(上皮钙黏素、β-连接素和细胞周期蛋白D)、肿瘤标志物(癌胚抗原、糖类抗原125和糖类抗原19-9)、近期并发症发生率和5年随访结果(死亡率、无病生存率和带病生存率)。结果腹腔镜组手术时间较开腹组长,术中出血量较开腹组少,肠鸣音恢复时间、排气时间、排便时间和离床活动时间短于开腹组,两组比较,差异均有统计学意义(P<0.05);两组术前血清指标和肿瘤标志物比较,差异均无统计学意义(P>0.05),术后均较术前明显改善,术前术后比较,差异均有统计学意义(P<0.05),两组术后血清指标和肿瘤标志物比较,差异均无统计学意义(P>0.05);腹腔镜组近期并发症发生率(5.0%)低于开腹组(15.0%),两组比较,差异有统计学意义(P<0.05);两组死亡率(0.0%和0.0%)、5年无病生存率(90.0%和95.0%)和5年带病生存率(10.0%和5.0%)比较,差异均无统计学意义(P>0.05)。结论在仅侵犯胆囊黏膜或黏膜固有层的胆囊癌治疗中,腹腔镜胆囊癌根治术的临床疗效具有较大优势,但远期预后与开腹根治术相当,可作为优选治疗方案来推广应用。

Objective To study the effect and long-term prognosis of laparoscopic cholecystectomy for the gallbladder carcinoma involving only the mucosa or mucosal lamina propria of gallbladder.Methods 80 patients with gallbladder cancer involving only the mucosa or mucosal lamina propria from January 2013 to June 2014,were divided into open group(treated with open radical surgery)and laparoscopic gallbladder randomly(treated with laparoscopic radical gallbladder carcinoma).The perioperative indicators of the two groups(operative time,intraoperative blood loss,bowel sound recovery time,exhaust time,defecation time and time out of the bed),serum indexes(epithelial cadherin,β-catenin and cyclin D),tumor markers(carcinoembryonic antigen,carbohydrate antigen 125 and carbohydrate antigen 19-9),incidence of recent complication rate,5-year follow-up results(mortality,disease-free survival and disease-carrying survival rate.Results The operation time of laparoscopic group was longer than that of open group,the amount of intraoperative blood loss was less than that of open group,recovery time of bowel sounds,exhaust time,defecation time and ambulation time were shorter than those of open group,the difference was statistically significant(P<0.05);there was no significant difference in preoperative serum indexes and tumor markers between the two groups(P>0.05),and the postoperative improvement was obvious;there was no significant difference in serum indexes and tumor markers between the two groups(P>0.05);the incidence of recent complications in laparoscopic group(5.0%)was lower than that in open group(15.0%),and the difference was statistically significant(P<0.05);the mortality rate(0.0%vs 0.0%)and the 5-year disease-free survival rate(90.0%vs 0.0%)in the two groups were statistically significant(P<0.05).There was no significant difference in the 5-year survival rate(10.0%vs 5.0%)between the two groups(P>0.05).Conclusion The clinical efficacy of laparoscopic radical cholecystectomy in treatment of gallbladder carcinoma involving only the mucosa or mucosal lamina propria is superior,but the long-term prognosis is comparable to the open radical surgery.It can be used as the preferred treatment.