T3期胆囊癌腹腔镜根治术中限量解剖性肝切除的应用效果分析

Application of limited anatomical hepatectomy in laparoscopic radical resection for stage T3 gallbladder carcinoma

目的探讨T3期胆囊癌腹腔镜根治术中采用腹腔镜限量解剖性肝切除(LLAH)的治疗效果。方法回顾性分析咸阳市中心医院肝胆外科2018年3月至2021年6月间收治的T3期胆囊癌患者62例,其中行传统腹腔镜解剖性肝切除30例(传统组),行LLAH 32例(LLAH组)。比较两组患者围手术期情况及术后生存率差异。结果两组患者术前一般资料具有可比性。与传统组相比,LLAH组手术完成时间更长[(185±50)min vs(150±35)min,t=1.635,P=0.042],但术中出血量更少[(350±150)mL vs(550±250)mL,t=-2.526,P=0.032]、术后并发症发生率更低[6例(18.8%)vs 9例(30.0%),χ^(2)=3.883,P=0.043]、肝功能不全发生率更低[2例(6.3%)vs 5例(16.7%),P=0.026]、术后住院时间更短[(6.0±1.6)d vs(8.1±2.6)d,t=-2.676,P=0.029],以上差异均具有统计学意义(P<0.05)。两组在根治术完成情况及住院费用方面比较,差异无统计学意义(P>0.05)。结论T3期胆囊癌腹腔镜根治术中应用LLAH,在完整切除肿瘤及荷瘤门静脉流域肝组织的同时可最大限度保留功能性肝脏的结构和体积;同时,LLAH术中出血量减少,使得术后并发症及肝功能不全发生率降低,患者恢复快,住院时间缩短。T3期胆囊癌腹腔镜根治术采用LLAH和传统解剖性肝切除的远期效果相当。

Objective To evaluate the application effect of laparoscopic limited anatomical hepatectomy(LLAH)in laparoscopic radical resection for stage T3 gallbladder carcinoma.Methods A retrospective analysis was conducted in 62 patients with stage T3 gallbladder carcinoma,who admitted to Xianyang Central Hospital between Mar.2018 and Jun.2021.Among them,30 underwent traditional laparoscopic anatomical hepatectomy(traditional group)and 32 underwent LLAH(LLAH group).The differences in perioperative indicators and postoperative survival rates between the two groups were compared.Results The general preoperative data between two groups were comparable.Compared with the traditional group,the completion time of the surgery in LLAH group was longer[(185±50)min vs(150±35)min,t=1.635,P=0.042],but the intraoperative bleeding volume was less[(350±150)mL vs(550±250)mL,t=-2.526,P=0.032],the postoperative complications incidence rate was lower[6(18.8%)vs 9(30.0%),χ^(2)=3.883,P=0.043],the liver dysfunction incidence rate was lower[2(6.3%)vs 5(16.7%),P=0.026],and the postoperative hospitalization time was shorter[(6.0±1.6)d vs(8.1±2.6)d,t=-2.676,P=0.029].There was no statistical difference between the two groups in terms of the surgical completion rate or hospitalization expense(P>0.05).Conclusion The application of LLAH in laparoscopic radical resection for stage T3 gallbladder carcinoma,which can preserve maximum structure and volume of the functional liver,while completely resecting the tumor and liver tissue in the tumor bearing portal vein basin.At the same time,the amount volume of bleeding during operation is reduced,resulting in a reduced postoperative complication incidence rate and liver dysfunction,and rapid patient recovery.The long-term results of laparoscopic radical resection for stage T3 gallbladder carcinoma with LLAH and traditional laparoscopic anatomical hepatectomy were comparable.