基于倾向性评分匹配腹腔镜胆囊切除术治疗Tis-T2a期胆囊癌的安全性及疗效分析

A propensity score matching study on safety and efficacy of laparoscopic cholecystectomy for T2a and lower stages of gallbladder carcinoma

目的评估腹腔镜胆囊切除术(LC)治疗T2a及以下分期胆囊癌的安全性及疗效。方法回顾性分析湖南省人民医院2016年1月至2021年1月行手术治疗、经病理确诊为胆囊癌的患者临床资料,根据手术方式分为单纯组与根治组:单纯组为64例接受LC的意外胆囊癌患者,根治组为30例接受腹腔镜胆囊癌根治术(LRC)的患者。通过倾向性评分匹配将两组患者基线资料进行1∶1匹配。匹配后单纯组与根治组患者各26例,其中单纯组男性7例,女性19例,年龄(60.6±9.6)岁;根治组男性8例,女性18例,年龄(60.9±9.1)岁。比较两组患者的术中出血量、手术时间、术后住院时间、无瘤生存率,以及胆漏、急性肺栓塞、切口感染等术后并发症指标的差异。结果单纯组手术时间(78.7±62.9)min、术中出血量(10.7±11.6)ml、术后住院时间(4.4±2.6)d均优于根治组的手术时间(298.7±101.3)min、术中出血量(161.9±96.7)ml、术后住院时间(9.9±4.0)d,差异均有统计学意义(均P<0.05)。两组患者在术后并发症、无瘤生存率方面,差异无统计学意义(均P>0.05)。结论LC对于T2a及以下分期胆囊癌治疗安全有效,可取得与LRC相似的无瘤生存率。

Objective To study the safety and efficacy of laparoscopic cholecystectomy(LC)in treatment of T2a and lower stages of gallbladder carcinoma.Methods A retrospective study was performed on patients who were diagnosed with gallbladder cancer and underwent surgical treatment from January 2016 to January 2021 at Hunan Provincial People's Hospital.These patients were divided into the simple treatment group and the radical treatment group based on the surgical methods used.The simple treatment group consisted of 64 patients who underwent LC for accidental gallbladder cancers.The radical treatment group consisted of 30 patients who underwent laparoscopic radical cholecystectomy(LRC).The baseline characteristic of the two groups of patients were matched in a 1∶1 ratio using propensity score matching.After matching,there were 26 patients in each of the 2 groups.There were 7 males and 19 females in the simple group,with mean±s.d.age of(60.6±9.6)years.There were 8 males and 18 females,with mean±s.d.age(60.9±9.1)years in the radical treatment group.Blood loss,operation time,postoperative hospital stay,biliary leakage,acute pulmonary embolism,and incisional infection were compared between the two groups.Results In the simple group,the operative time was(78.7±62.9)min,intraoperative blood loss was(10.7±11.6)ml and postoperative hospital stay was(4.4±2.6)d.These results were significantly better than those in the radical group with operative time(298.7±101.3)min,intraoperative blood loss(161.9±96.7)ml and postoperative hospital stay(9.9±4.0)d(all P<0.05).There were no significant difference in the postoperative complications and disease free survival rates between the two groups(both P>0.05).Conclusion LC was safe and effective for treatment of T2a and lower stages of gallbladder cancer,and it could achieve a similar disease-free survival rate as LRC.