肝内胆管细胞癌根治术中淋巴结清扫现状分析——一项单中心回顾性研究

Current Status of Lymphadenectomy during Radical Resection of Intrahepatic Cholangiocarcinoma:a Single-center Retrospective Study

背景淋巴结转移是影响肝内胆管细胞癌患者预后的重要因素,对于术中淋巴结清扫的范围目前国内外仍存在争议。目的探索临床肝内胆管细胞癌根治术中淋巴结清扫现状。方法本文通过回顾性分析2017—2022年在浙江省肿瘤医院接受根治性切除手术的152例肝内胆管细胞癌患者的临床资料,对目前临床进行肝内胆管细胞癌根治术时淋巴结清扫情况,包括是否行淋巴结清扫、淋巴结清扫范围及主要阳性淋巴结分布情况进行分析。根据肿瘤在肝脏的位置分为左肝和右肝。结果152例患者中,83例患者肿瘤位于左肝,69例位于右肝。共86例患者接受淋巴结清扫术,左肝肿瘤患者接受淋巴结清扫比例[61例(73.5%)]高于右肝肿瘤患者[25例(36.2%)](P<0.05);平均清扫淋巴结数目为(7.6±6.1)枚,左肝肿瘤患者[7.0(4.0,10.5)枚]和右肝肿瘤患者[5.0(1.5,9.5)枚]清扫淋巴结数目比较,差异无统计学意义(P>0.05);86例接受淋巴结清扫的患者中,有39例(45.3%)病理学结果显示淋巴结转移(淋巴结阳性),左肝肿瘤患者淋巴结阳性率[34例(55.7%)]高于右肝肿瘤患者[5例(20.0%)](P<0.05);不论肿瘤位于左肝还是右肝,常规区域内清扫的阳性淋巴结中占比较高的均为第8、12、13组,其中排名第1位的为第12组,左肝肿瘤患者和右肝肿瘤患者分别为79.4%(27/34)和80.0%(4/5)。结论不论肿瘤位于左肝还是右肝,第8、12、13组淋巴结是阳性率较高的淋巴结,术中可能需要常规进行清扫。

Background Lymph node metastasis is an important factor affecting the prognosis of patients with intrahepatic cholangiocarcinoma,but lymphadenectomy extent remains controversial both domestically and internationally.Objective To explore the current status of lymphadenectomy during radical resection of intrahepatic cholangiocarcinoma.Methods A retrospective analysis of the clinical data of 152 patients with intrahepatic cholangiocarcinoma who underwent radical resection at Zhejiang Cancer Hospital from 2017 to 2022 was conducted to determine the current status of lymphadenectomy during radical resection of intrahepatic cholangiocarcinoma,including the decision to perform lymphadenectomy,the extent of lymphadenectomy and the distribution of positive lymph nodes.The patients were divided into the left hemi-liver group and right hemi-liver group according to the location of the tumour in the liver.Results A total of 152 patients were selected,including 83 patients in the left hemi-liver group and 69 in the right hemi-liver group.Eighty-six of them underwently mphadenectomy,accounting for higher proportion in the left hemi-liver group〔61 cases(73.5%)〕than the right hemi-liver group〔25 cases(36.2%)〕(P<0.05).The average number of dissected lymph nodes was(7.6±6.1),with no significant difference between the left〔7.0(4.0,10.5)〕and right hemi-liver groups〔5.0(1.5,9.5)〕(P>0.05).Of the 86 patients underwent lymphadenectomy,39(45.3%)cases showed lymph node metastasis(positive lymph nodes)on pathological examination,accounting for higher proportion in the left hemi-liver group〔34 cases(55.7%)〕than the right hemi-liver group〔5 cases(20.0%)〕(P<0.05).Regardless of which lobe the tumour was located,lymph node stations 8,12,and 13 accounted for a higher proportion of metastasis in routine dissection areas,among which the proportion of lymph nodes station 12 was the highest,with 79.4%(27/34)in the left hemi-liver group and 80.0%(4/5)in the right hemi-liver group.Conclusion Regardless of the location of tumour,lymph node stations 8,12 and 13 have a higher incidence of lymph node metastasis and should be considered for routine dissection during radical resection.