En-bloc淋巴结清扫在腹腔镜胆囊癌根治术中的应用

Application of en-bloc lymph node dissection in laparoscopic radical resection for gallbladder cancer

目的探讨en-bloc淋巴结清扫在腹腔镜胆囊癌根治术中的安全性和可行性。方法回顾性分析2014年1月至2022年2月于浙江省人民医院接受腹腔镜胆囊癌根治术的87例胆囊癌患者的临床资料,其中男性26例,女性61例,年龄67.0(59.0,72.0)岁。依据淋巴结清扫手术方式分为en-bloc清扫组(n=29)与非en-bloc清扫组(n=58)。比较两组患者一般资料、肿瘤特征、手术情况及复发生存等指标的差异。利用电话随访患者的术后生存状态。结果 En-bloc清扫组的淋巴结清扫数目9.0(8.0,12.0)个多于非en-bloc清扫组的8.0(4.8,11.0)个,差异有统计学意义(Z=-2.39,P=0.017)。两组患者在年龄、性别、术前血生化指标、肿瘤糖类抗原19-9、肿瘤分期、神经和脉管侵犯、手术时间、术中出血量、术后引流管留置时间、术后住院时间、术后并发症(胆瘘、腹腔出血及腹腔感染)发生率方面差异均无统计学意义(均P>0.05)。En-bloc清扫组患者的中位生存时间长于非en-bloc清扫组患者(21比15个月),En-bloc清扫组患者的中位无复发生存时间为18个月,也长于非en-bloc清扫组患者的10个月,但两组患者术后的累积生存率和累积无复发生存率间差异均无统计学意义(均P>0.05)。结论在腹腔镜胆囊癌根治术中,en-bloc淋巴结清扫术安全可行,可比非en-bloc淋巴结清扫术获得更多的淋巴结。

Objective To study the safety and feasibility of en-bloc lymph node dissection in laparoscopic radical resection for gallbladder cancer(GBC).Methods The clinical data of 87 patients who underwent laparoscopic radical resection for GBC at Zhejiang Provincial People's Hospital from January 2014 to February 2022 were retrospectively analyzed.There were 26 males and 61 females,aged 67.0(59.0,72.0)years old.The patients were divided into the en-bloc dissection group(n=29)and the non-en-bloc dissection group(n=58)based on whether en-bloc lymph node dissection was carried out.Differences in general data,tumor characteristics,operation,recurrence and survival were compared between the two groups.Postoperative survival status of these patients was followed-up by telephone.Results The number of lymph nodes dissected in the en-bloc dissection group was 9.0(8.0,12.0),which was significantly higher than the 8.0(4.8,11.0)in the non-en-bloc dissection group(Z=-2.39,P=0.017).There were no significant differences in age,gender,preoperative blood biochemical indexes,tumor carbohydrate antigen 19-9,tumor stage,nerve and vascular invasion,operation time,intraoperative blood loss,postoperative drainage tube retention time,postoperative hospital stay,and incidences of postoperative complications(biliary fistula,abdominal hemorrhage and abdominal infection)between the two groups(all P>0.05).The median survival was longer in the en-bloc group than in the non-en-bloc group(21 vs.15 months),and the median relapse-free survival time was 18 months in the en-bloc group compared with 10 months in the non-en-bloc group.However,there were no significant differences in postoperative cumulative survival and recurrence-free survival between the two groups(all P>0.05).Conclusion En-bloc lymphadenectomy was safe and feasible in laparoscopic radical GBC surgery,with more lymph nodes being removed than the non-en-bloc lymphadenectomy group.