腹腔镜与开腹胆囊癌根治术治疗早期胆囊癌的临床研究

Clinical study of laparoscopic and laparotomic radical resection for early gallbladder cancer

目的探讨腹腔镜与开腹胆囊癌根治术治疗早期胆囊癌的临床研究。方法回顾性选取2014年1月至2017年7月间空军军医大学第二附属医院收治的行胆囊癌根治术的71例早期胆囊癌患者,根据手术方式不同分为开腹组38例和腹腔镜组33例。腹腔镜组患者行腹腔镜胆囊癌根治术,开腹组患者行开腹胆囊癌根治术,比较两组患者围手术期指标、术后并发症、免疫应激指标、预后无病生存及总生存情况。结果两组患者术中均顺利完成手术,无围手术期死亡或腹腔镜中转开腹手术病例。腹腔镜组患者手术时间、术中出血量、术后排气时间、胃肠功能恢复时间、下床活动时间及住院时间均优于开腹组,差异均有统计学意义(均P<0.05);两组患者淋巴结清扫数目比较,差异无统计学意义(P>0.05)。腹腔镜组患者术后并发症发生率为24.2%,低于开腹组的44.7%,差异有统计学意义(P<0.05)。术前,两组患者免疫应激指标比较,差异无统计学意义(P>0.05)。术后1周,两组患者免疫球蛋白M(IgM)、IgA和IgG均较术前降低,血糖和C反应蛋白(CRP)均较术前升高,且腹腔镜组降低和升高幅度小于开腹组,差异均有统计学意义(均P<0.05)。至随访截止时间,随访4~36个月,中位23个月,开腹组患者失访2例,复发7例,存活23例,死亡6例;腹腔镜组患者失访1例,复发4例,存活24例,死亡4例。两组患者术后无病生存时间和总生存时间比较,差异均无统计学意义(P>0.05)。结论腹腔镜胆囊癌根治术治疗早期胆囊癌与开腹手术效果相近,且手术创伤小,术后恢复快,并发症少,对机体免疫和应激影响小,安全可行。

Objective To investigate the clinical efficacy of laparoscopic and laparotomic radical resection for the treatment of early gallbladder carcinoma.Methods A total of 71 patients with gallbladder cancer who underwent radical cholecystectomy were selected at The Second Affiliated Hospital of Air Force Military Medical University General surgery from January 2014 to July 2017.According to different surgi-cal methods,they were categorized into a laparotomic surgery group(38 patients)and a laparoscopic sur-gery group(33 patients).Perioperative indicators,postoperative complications,immune stress indicators,disease-free survival and overall survival were compared between the two groups.Results Patients in both groups completed surgery successfully and no perioperative death or laparoscopic procedure conversion to laparotomic procedure occurred.The operative time,intraoperative blood loss,postoperative exhaust time,gastrointestinal function recovery time,out-of-bed activity time and hospital stay length were better in the laparoscopic surgery group than those in the laparotomic surgery group(all P<0.05).No significant differ-ence was found in number of dissected lymph nodes between the two groups(P>0.05).The incidence of postoperative complications was 24.2%in the laparoscopic surgery group which was lower than 44.7%of the laparotomic surgery group(P<0.05).At 1 week after the operation,IgM,IgA and IgG levels were lower in the two groups than those before the operation,and blood G(BG)and C-reactive protein(CRP)levels were higher than those before the operation,and these levels were better in the laparoscopic surgery group than in the laparotomic group(all P<0.05).There was no statistical difference in disease-free sur-vival and overall survival between the two groups(P>0.05).Conclusion Laparoscopic radical cholecys-tectomy for early gallbladder cancer is similar to laparotomic surgery and the former had less surgical trau-ma,quick postoperative recovery,fewer complications,less impact on immunity and stress,which is safe and feasible.