腹腔镜胆囊切除联合肝组织楔形切除及区域淋巴结清扫术治疗T1b期胆囊癌的临床效果

Clinical effect of laparoscopic cholecystectomy combined with liver tissue wedge resection and regional lymph node dissection in the treatment of T1b gallbladder cancer

目的探讨T1b期胆囊癌(GBC)患者采用腹腔镜胆囊切除(LC)联合肝组织楔形切除、区域淋巴结清扫术治疗的临床效果。方法选取2016年2月至2020年1月在河南省人民医院接受治疗的T1b期GBC患者共计86例,以随机数字表法分为研究组(n=44,LC联合肝组织楔形切除、区域淋巴结清扫术治疗)与对照组(n=42,LC治疗),对两组围手术期指标、疼痛程度[痛觉模拟评分法(VAS)]、肿瘤标志物、生活质量[世界卫生组织生存质量测定量表简表(WHOQOL-BREF)]、并发症发生率、生存率进行比较。结果研究组手术时间、胃肠功能恢复时间、住院时间长于对照组,且出血量多于对照组,差异有统计学意义(P<0.05);研究组术后24 h、72 h VAS评分与对照组比较,差异无统计学意义(P>0.05);两组术后72 h癌胚抗原(CEA)、血清糖类抗原19-9(CA19-9)水平降低,差异有统计学意义(P<0.05),但研究组与对照组比较,差异无统计学意义(P>0.05);两组术后1个月WHOQOL-BREF评分提高,且研究组评分高于对照组,差异有统计学意义(P<0.05);研究组并发症发生率(11.36%)与对照组(7.14%)比较,差异无统计学意义(P>0.05);研究组术后3年生存率(36.36%)较对照组(16.67%)更高,差异有统计学意义(P<0.05)。结论LC联合肝组织楔形切除、区域淋巴结清扫术应用于T1b期GBC患者治疗中,能够提高生活质量,提高远期生存率,不会增加术后并发症,但手术时间更长,术中出血量更多,恢复时间更长。

Objective To explore the clinical efficacy of LC combined with liver tissue wedge resection and regional lymph node dissection in the treatment of T1b GBC.Methods A total of 86 T1b GBC patients who were received treatment in Henan Provincial People’s Hospital from February 2016 to January 2020 were selected,and randomly divided into the study group(n=44,LC combined with liver tissue wedge resection and regional lymph node dissection treatment)and the control group(n=42,LC treatment).The perioperative indicators,pain level(VAS),tumor markers,quality of life(WHOQOL-BREF),incidence of complications,and survival rate in both groups were compared.Results In comparision of the control group,the surgery time,gastrointestinal function recovery time,and hospital stay in the study group were longer(P<0.05),and bleeding was more(P<0.05).In VAS scores,there was no statistically significant difference in the study group and the control group at 24 and 72 hours after surgery(P>0.05).The CEA and CA19-9 levels in both groups were decreased 72 hours after surgery(P<0.05),but there was no significant difference in the study group and the control group(P>0.05).1 month after surgery,the WHOQOL-BREF score in both groups were improved(P<0.05),and in comparision of the control group,the study group was higher(P<0.05).There was no statistically significant difference in the incidence of complications between the study group(11.36%)and the control group(7.14%)(P>0.05).In the 3-year postoperative survival rate,in comparision of the control group(16.67%),the study group(36.36%)was higher(P<0.05).Conclusion The application of LC combined with liver tissue wedge resection and regional lymph node dissection in the treatment of T1b GBC patients can improve the quality of life,improve long-term survival rate,and not increase postoperative complications.But the surgical time is longer,the intraoperative blood output is more,and the recovery time is longer.