腹腔镜手术与开腹手术治疗肝内胆管细胞癌的疗效对比研究

Comparative study of laparoscopic surgery and open surgery in the treatment of intrahepatic cholangiocarcinoma

目的比较腹腔镜手术与开腹手术治疗肝内胆管细胞癌的短期与中长期疗效。方法采用回顾性队列研究方法,连续性收集2015年1月至2020年6月山东大学齐鲁医院普通外科手术治疗的118例肝内胆管细胞癌患者临床资料,根据手术方式分为腹腔镜组与开腹组,统计并比较两组患者的术中情况、住院费用、术后并发症、血生化指标等围手术期资料以及随访资料,评价两者的治疗效果。结果腹腔镜组患者40例,男性18例,女性22例,年龄(61.5±9.1)岁;开腹组患者78例,男性48例,女性30例,年龄(61.2±8.3)岁。腹腔镜组肿瘤长径(4.4±1.8)cm小于开腹组(6.0±3.3)cm,差异具有统计学意义(P<0.05)。腹腔镜组有4例(10%)患者中转开腹。腹腔镜组术中出血量、术中输血、切除≥3个肝段的患者比例及住院费用均低于开腹组[200.0(100.0,261.8)ml比300.0(100.0,400.0)ml,5.0%(2/40)比26.9%(21/78),37.5%(15/40)比66.7%(52/78),(6.2±2.0)万元比(7.2±2.3)万元],差异均具有统计学意义(P<0.05)。两组患者术后并发症发生率差异无统计学意义(P>0.05)。腹腔镜组患者术后第1天丙氨酸氨基转移酶水平和术后第3天总胆红素水平均低于开腹组[188.5(130.5,274.0)U/L比320.0(144.0,427.0)U/L,26.4(18.3,26.4)μmol/L比31.6(18.8,37.5)μmol/L],差异有统计学意义(P<0.05)。两组患者术后1、2年的总生存率和无病生存率比较差异无统计学意义(P>0.05)。结论与开腹手术相比,腹腔镜手术治疗肝内胆管细胞癌在短期疗效上具有优势,在中长期疗效上两者效果相当。

Objective To compare the differences of short and long-term outcomes between laparoscopic surgery and open surgery treatment of intrahepatic cholangiocarcinoma patients.Methods A retrospective cohort study was conducted to collect the clinical data of 118 patients with intrahepatic cholangiocarcinoma who underwent surgery in Qilu Hospital of Shandong University from January 2015 to June 2020.They were divided into laparoscopy group and open group according to the operation methods.The perioperative data,such as intraoperative surgical conditions,hospital costs,postoperative complications,postoperative blood biochemical tests,and the follow-up data of the two groups were compared.Results In the laparoscopic group,there were 40 patients,18 males and 22 females,aged(61.5±9.1)years.There were 78 patients in the open group,48 males and 30 females,aged(61.2±8.3)years.The tumor size of the laparoscopic group was(4.4±1.8)cm,which was smaller than that of the open group(6.0±3.3)cm,and the differences were statistically significant(P<0.05).In the laparoscopic group,4 cases(10%)were converted to open surgery.The intraoperative blood loss,intraoperative blood transfusion proportion,3 or more liver segments resection proportion and hospital costs of laparoscopic group were lower than those of open group[200.0(100.0,261.8)ml vs.300.0(100.0,400.0)ml,5.0%(2/40)vs.26.9%(21/78),37.5%(15/40)vs.66.7%(52/78),(6.2±2.0)wan yuan vs.(7.2±2.3)wan yuan],the differences were statistically significant(all P<0.05).There were no significant differences in the incidence of postoperative complications between the two groups(P>0.05).On the first post-operative day,ALT serum level and the third post-operative day TBil serum level in the laparoscopic group were lower than those in the open group[188.5(130.5,274.0)U/L vs.320.0(144.0,427.0)U/L,26.4(18.3,26.4)μmol/L vs.31.6(18.8,37.5)μmol/l],the differences were statistically significant(P<0.05).There were no significant differences in 1-year and 2-year overall survival rate and disease-free survival rate between the two groups(P>0.05).Conclusion Compared with open surgery,laparoscopic surgery in the treatment of intrahepatic cholangiocarcinoma has better short-term outcomes,and can achieve similar results in medium-or long-term outcomes.