不同切除范围的Bismuth-CorletteⅢ、Ⅳ型腹腔镜肝门部胆管癌手术临床对比分析

Clinical comparative analysis of Bismuth-Corlette Ⅲ and Ⅳ laparoscopic surgery for hilar cholangiocarcinoma with different resection scopes

目的对比分析不同切除范围的Bismuth-CorlettⅢ、Ⅳ型腹腔镜肝门部胆管癌手术临床效果。方法选取2020年1月至2022年12月68例Bismuth-CorletteⅢ、Ⅳ型肝门部胆管癌(HCCA)患者作为研究对象,采用随机数字表法将患者分为大范围肝切除组和小范围肝切除组,每组各34例。两组患者均于腹腔镜指导下进行,大范围切除组行半肝切除切除或三叶肝切除联合全尾状叶切除术,小范围切除组行围肝门区切除并联合全尾状叶切除术。数据应用软件SPSS 22.0处理。围手术期相关指标等计量资料采用(x±s)表示,组间比较行独立样本t检验;术后并发症等计数资料采用[例(%)]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为差异有统计学意义。结果小范围切除组手术时间、术中出血量及术后住院时间均显著低于大范围切除组(P<0.05);两组患者术中输血率及RO切除率比较,差异均无统计学意义(P>0.05)。术后各时间点的各肝功能指标与术前比较差异均有统计学意义(P<0.05),且小范围切除组显著优于大范围切除组(P<0.05)。小范围切除组患者术后总并发症发生率较大范围切除组显著降低(11.8%vs.32.4%,P<0.05)。中位随访时间25个月,通过Kaplan-Meier分析显示,小范围切除组和大范围切除组患者累积总生存率(58.8%vs.67.6%)及累积无病生存率(76.5%vs.65.8%)比较,差异无统计学意义(P=0.441、0.212)。结论与腹腔镜大范围肝切除相比,小范围肝切除治疗Bismuth-CorletteⅢ、Ⅳ型HCCA不仅可有效缩短手术时间,减少术中损伤,加快术后恢复,降低术后并发症的发生,提高了手术的安全性,而且更有利于患者术后肝功能的恢复。

Objective To compare and analyze the clinical effects of Bismuth-Corlette Ⅲ and Ⅳ laparoscopic surgery for hilar cholangiocarcinoma in different resection scopes.Methods A total of 68 patients with Bismuth-Corlette Ⅲ and Ⅳ hilar cholangiocarcinoma(HCCA)from January 2020 to December 2022 were selected as the study objects.The patients were divided into a large hepatectomy group and a small hepatectomy group by random number table method,with 34 cases in each group.Both groups were performed under the guidance of laparoscopy.The large resection group underwent hemihepatectomy or three-lobe hepatectomy combined with total caudate lobectomy,and the small resection group underwent periportal resection combined with total caudate lobectomy.The data was processed by SPSS 22.0.Perioperative indicators and other measurement data were expressed by(x±s),and independent t test was performed for inter-group comparison.The statistical data of postoperative complications were expressed by[n(%)]and χ^(2) test was performed.Kaplan-Meier method and Log-Rank test were used for survival analysis.P<0.05 was considered statistically significant.Results The operative time,intraoperative blood loss and postoperative hospital stay in the small resection group were significantly lower than those in the large resection group(P<0.05),There was no significant difference in the intraoperative blood transfusion rate and RO removal rate between the two groups(P>0.05).There were statistically significant differences in liver function indexes at all time points after surgery compared with those before surgery(P<0.05),and the small resection group was significantly better than the large resection group(P<0.05).The ineidence of total postoperative complications in the small resection group was significantly reduced in the large resection group(11.8%vs.32.4%,P<0.05).After a median follow-up of 25 months,Kaplan-Meier analysis showed that cumulative overall survival(58.8%us.67.6%)and cumulative disease-free survival(76.5%vs.65.8%)were not statistically significant between the small resection group and the large resection group(P=0.441,0.212).Conclusion Compared with laparoscopic large-scale hepatectomy,the treatment of Bismuth-Corlette Ⅲ and Ⅳ HCCA with small-scale hepatectomy can not only effctively shorten the operation time,reduce intraoperative injury,accelerate postoperative recovery,reduce postoperative complications,improve the safety of surgery,but also be more conducive to the recovery of postoperative liver function of patients.