解剖性与非解剖性肝切除术治疗肝胆管结石合并肝内胆管癌的临床研究

Clinical study of anatomical and non-anatomical hepatectomy for hepatolithiasis-associated intrahepatic cholangiocarcinoma

目的探讨解剖性与非解剖性肝切除术治疗肝胆管结石合并肝内胆管癌(HICC)的临床疗效。方法前瞻性纳入2017年1月至2020年6月64例HICC患者的临床资料,随机分为非解剖组和解剖组各32例。非解剖组行非解剖性肝切除术,解剖组行解剖性肝切除术。采用软件SPSS 22.0处理数据,围术期指标、肝功能指标等计量资料以(-x±s)表示,行独立样本t检验;术后并发症等计数资料以n(%)表示,行χ^(2)检验;生存分析采用Kaplan-Meier法并行Log-rank检验。P<0.05表示差异有统计学意义。结果解剖组手术时间长于非解剖组(P<0.05),解剖组术中出血量、术中输血量、手术切缘均明显优于非解剖组(P<0.05);解剖组患者术后第1 d、3 d、7 d总胆红素(TBil)、谷草转氨酶(AST)、谷丙转氨酶(ALT)水平均显著低于非解剖组(P<0.05),血清白蛋白(ALB)水平显著高于非解剖组(P<0.05);解剖组患者术后总并发症发生率较非解剖组显著降低(9.4%vs.31.3%,P<0.05);术后随访7~48个月,中位随访28个月,解剖组与非解剖组两组患者的累积总生存率(53.1%vs.56.3%)及无病生存率(37.5%vs.46.9%)比较,差异均无统计学意义(Log Rankχ^(2)=0.084、0.547,P=0.772、0.460)。结论解剖性肝切除术虽然操作复杂,延长了手术时间,但更加精细化,不仅提高了手术的安全性,而且也有利于患者术后肝功能恢复、减少术后并发症。

Objective To investigate the clinical efficacy of anatomic and non-anatomic hepatectomy for hepatolithiasis-associated intrahepatic cholangiocarcinoma(HICC).Methods Clinical data of 64 patients with HICC from January 2017 to June 2020 were prospectively included.They were randomly divided into non-anatomical group and anatomical group,each of 32 cases.The non-anatomical group underwent non-anatomical hepatectomy,while the anatomical group underwent anatomical hepatectomy.SPSS 22.0 software was used for data processing.Perioperative indexes,liver function indexes and other measurement data were expressed as(-x±s),and independent t test was performed.Postoperative complications was expressed as n(%)andχ^(2) test was performed;Kaplan Meier method and log-rank test were used for survival analysis.P<0.05 indicated statistically significant difference.Results The operative time of the anatomical group was longer than that of the non-anatomical group,and the intraoperative blood loss,intraoperative blood transfusion and surgical margin of the anatomic group were significantly better than those of the non-anatomic group(P<0.05),while there was no statistical difference in the postoperative hospital stay between the two groups(P>0.05).The levels of TBil,AST and ALT in anatomical group on day 1,3 and 7 after surgery were significantly lower than those in non-anatomical group(P<0.05),and the level of ALB in anatomical group was significantly higher than that in non-anatomical group(P<0.05).The incidence of postoperative complications in the anatomical group was significantly lower than that in the non-anatomical group(9.4%vs.31.3%,P<0.05).The follow-up was 7~48 months,and the median was followed up for 28 months,there was no significant difference in the cumulative overall survival rate(53.1%vs.56.3%)and disease-free survival rate(37.5%vs.46.9%)between the two groups(log-rankχ^(2)=0.084,0.547,P=0.772,0.460).Conclusion Although the operation of anatomical hepatectomy is complex and prolongs the operation time,it is more refined,which not only improve the safety of operation,but also benefit the recovery of postoperative liver function and reduce postoperative complications.