两种不同取栓方法在肝细胞癌伴胆管癌栓中的对比研究

Comparative study of two different thrombectomy methods in hepatocellular carcinoma with cholangiocarcinomathrombectomy

目的对比研究肝细胞癌(HCC)伴胆管癌栓(BDTT)患者腹腔镜肝切除术中两种不同取栓方法的临床效果。方法回顾性分析2017年1月至2020年12月HCC伴BDTT41例患者临床资料,所有患者均行腹腔镜肝切除术,根据术中取栓方法不同分为两组,观察组21例行胆管切开取栓,对照组20例行肝外胆管切除。采用SPSS22.0软件完成数据分析,术后并发症等计数资料采用×检验或Fisher精确检验;围手术期指标等计量资料采用(x±s)表示,组间比较行t检验;Kaplan-Meier生存曲线分析累积总生存率(OS)和无病生存率(DFS)情况。P<0.05为差异有统计学意义。结果观察组手术时间、术中出血量、引流管拔除时间和术后住院时间等指标均优于对照组(P<0.05);观察组患者术后远期并发症发生率显著低于对照组(P<0.05);两组患者术后累积DFS和OS比较,差异无统计学意义(Log-RankX=0.092,P=0.761;X=0.030,P=0.863)。结论腹腔镜肝切除术中应用胆管切开取栓与肝外胆管切除治疗HCC伴BDTT手术安全性及预后近似,但胆管切开取栓具有手术时间短、出血少、拔除引流管时间早、远期并发症发生率低等优势,更利于患者术后恢复。

ObjectiveTo compare the clinical effects of two different thrombectomy methods in laparoscopic hepatectomy for hepatocellular carcinoma(HCC)with bile duct carcinoma thrombus(BDTT).MethodsClinical data of 41 patients with HCC accompanied by BDTT from January 2017 to December 2020 were retrospectively analyzed.All patients underwent laparoscopic hepatectomy and were divided into two groups according to dfferent methods of intraoperative thrombectomy:21 patients in the observation group underwent cholangiectomy and 20 patients in the control group underwent extrahepatic cholangiectomy.SPSS 22.O software was used to complete the data analysis,and the enumerations of postoperative complications were performed by X test or Fisher exact test.Measurement data such as perioperative indexes were expressed by(x+s),and t test was performed for comparison between groups.Kaplan-Meier survival curve was used to analyze cumulative overall survival(OS)and disease-free survival(DFS).P<0.05 was considered statistically significant.ResultsOperative time,intraoperative blood loss,drainage tube removal time and postoperative hospital stay in observation group were all better than those in control group(P<0.05).The incidence of postoperative long-term complications in observation group was significantly lower than that in control group(P<0.05).Postoperative cumulative DFS and OS between the two groups showed no significant difference(Log-RankX=0.092,P=0.761;X=0.030,P=0.863).Conclusion Laparoscopic choledochotomy and extrahepatic choledochotomy in the treatment of HCC with BDTT have similar surgical safety and prognosis,but choledochotomy and choledochotomy have advantages of short operation time,less bleeding,earlier removal of drainage tube and low incidence of long-term complications,which are more conducive to postoperative recovery of patients.