腹腔镜与开腹肝门部胆管癌根治术近期疗效的比较

Laparoscopic versus open radical resection for hilar cholangiocarcinoma

目的比较腹腔镜肝门部胆管癌根治术与开腹肝门部胆管癌根治术的临床疗效。方法回顾性分析2017年1月至2020年1月浙江省人民医院肝胆胰外科收治的34例接受肝门部胆管癌根治术患者的临床资料。根据手术方式将患者分为开腹组(n=17)和腹腔镜组(n=17)。对比两组患者围术期情况、术后进食时间、下床时间、引流管留置时间、住院时间、术后30 d死亡率及术后90 d死亡率等临床资料。结果34例接受肝门部胆管癌根治术的患者,年龄(64.3±1.7)岁,其中男性16例,女性18例。开腹组患者的手术时间为(436.2±33.4)min,腹腔镜组患者的手术时间为(522.1±24.0)min,两组比较,差异具有统计学意义(P<0.05)。两组患者在手术术式、术中出血量、门静脉重建、淋巴结数目以及肿瘤大小等方面差异无统计学意义(P>0.05)。腹腔镜组患者在术后进食时间[(4.7±0.3)比(4.6±0.3)d]、术后下床时间[(2.9±0.4)比(2.2±0.3)d)]、引流管留置时间[(12.7±1.3)比(11.1±1.0)d]、术后住院时间[(18.3±1.7)比(15.8±1.3)d]方面有优于开腹组的趋势,但两组比较,差异无统计学意义(P>0.05)。结论腹腔镜肝门部胆管癌根治术安全可行,在恰当选择的患者中能够达到不差于开腹手术的近期治疗效果,且可能有助于患者的快速康复。

Objective To compare the treatment outcomes between laparoscopic versus open radical resection for hilar cholangiocarcinoma(HCCA).Methods From January 2017 to January 2020,the clinical data of 34 patients who underwent radical resection for HCCA were retrospectively collected and analyzed.These patients were divided into the laparotomy group(n=17)and the laparoscopic group(n=17)based on the operation they received.Clinical data including perioperative outcomes,oral re-intake time,first out-of-bed activity time,drainage tube removal time,postoperative hospital stay,30-day and 90-day mortality rates were compared between groups.Results Of 34 patients who underwent radical for HCCA in the study,there were 16 males and 18 females,aged(64.3±1.7)years.The mean operation time of the laparotomy group was significantly less than those in the laparoscopic group[(436.2±33.4)vs(522.1±24.0)min,P<0.05].The 2 groups showed comparable results in extent of operation,intraoperative bleeding,incidences of portal vein reconstruction,yields of lymph nodes,and tumor diameter.The laparoscopic group showed advantage trends over the laparotomy group in incidences oral re-intake time[(4.7±0.3)vs(4.6±0.3)days],first out-of-bed activity time[(2.9±0.4)vs(2.2±0.3)days],drainage tube removal time[(12.7±1.3)vs(11.1±1.0)days]and postoperative hospital stay[(18.3±1.7)vs(15.8±1.3)days],but the differences failed to reach statistical significance(P>0.05).Conclusion Compared with open surgery,laparoscopic radical resection of HCCA in properly selected patients,was safe and feasible.There were comparable clinical outcomes.