倾向性评分匹配的微创胆囊癌意向性根治术的安全性及有效性

The safety and efficacy of minimally invasive curative-intent resection for gall-bladder carcinoma based on propensity score matching

目的探讨微创胆囊癌意向性根治术的安全性及有效性。方法回顾性分析2022年1月至2023年8月于西安交通大学第一附属医院肝胆外科因胆囊癌行意向性根治术的126例患者的临床病理资料,其中男性38例(30.2%),女性88例(69.8%);年龄40~88(63.3±8.8)岁;开腹组92例(73.0%),微创组34例(27.0%),其中微创组含5例行机器人辅助手术者。通过比较倾向性评分匹配(1:1匹配)前后两组患者临床病理资料的差异,分析开腹和微创组的手术耗时、术中出血量、术中输血量、淋巴结清扫数目、术后恢复、并发症发生、住院时间及住院费用。结果倾向性评分匹配后开腹和微创组基线资料比较,差异均无统计学意义(P>0.05)。微创组手术耗时长于开腹组(314.3±116.5 min vs.234.3±65.2 min,P=0.001),但两组患者在术中出血量、输注红细胞、输注血浆、是否阻断肝门、肝门阻断次数、肝门阻断时间、淋巴结清扫数目、阳性淋巴结数目、手术切缘比较,差异均无统计学意义(P>0.05);两组术后并发症发生情况及并发症C-D分级≥Ⅲ级者比较,差异无统计学意义(P>0.05);微创组患者术后首次进食时间及拔除引流管时间均短于开腹组(P<0.05);微创组术后住院时间短于开腹组(7.0 d vs.8.0 d,P=0.014),而住院总时间、总费用比较,差异无统计学意义(P>0.05)。结论微创胆囊癌根治术具有良好的手术安全性和有效性,可有助于患者快速恢复,具有一定的临床应用价值。

Objective To explore the safety and efficacy of minimally invasive curative-intent resection for gallbladder carci-noma.Methods The clinicopathological data of 126 patients who underwent curative-intent resection for gallbladder carcinoma in the Department of Hepatobiliary Surgery of First Affiliated Hospital of Xi’an Jiaotong University from January 2022 to August 2023 was ret-rospectively analyzed.There were 38 males patients(30.2%)and 88 females patients(69.8%);age 40 to 88(63.3±8.8)years old;and there were 92 cases in the open surgery group(73.0%)and 34 cases(27.0%)in the minimally invasive surgery group,of which in-cluded 5 cases who underwent robotic-assisted surgery.By comparing the clinicopathological data differences between the open surgery group and the minimally invasive surgery group before and after propensity score matching(1:1 matching),we analyzed the operative time,intraoperative bleeding,intraoperative blood transfusion,number of lymph node dissection,postoperative recovery,occurrence of complications,length of hospital stays,and hospital costs between the two groups.Results There was no statistically significant differ-ence in baseline data between the open surgery group and the minimally invasive surgery group after propensity score matching(P>0.05).The results showed that the minimally invasive surgery group had a longer operation time than that in the open surgery group(314.3±116.5 min vs.234.3±65.2 min,P=0.001),but there were no statistical differences between the two groups in the intraopera-tive bleeding,intraoperative transfusion of erythrocytes,transfusion of plasma,whether the hepatic hilum was blocked,number of he-patic hilum blocks,duration of hepatic hilum block,number of lymph node dissection,number of positive lymph nodes,and surgical margins(P>0.05);there was no statistically significant difference between the two groups in the occurrence of postoperative complica-tions and those with C-D grading of complications≥grade III(P>0.05);the time for the first postoperative meal and the time for re-moving the drainage tube in the minimally invasive group were shorter than those in the open surgery group(P<0.05);the postopera-tive hospital stay in the minimally invasive surgery group was shorter than that of the open surgery group(7.0 d vs.8.0 d,P=0.014),and there was no statistically significant difference in the total length of hospital stays and the total hospital costs(P>0.05).Conclu-sion Minimally invasive curative-intent resection of gallbladder carcinoma showed good surgical safety and efficacy,which could help patients recover quickly,and had certain clinical application value.