腹腔镜下胆囊切除术联合淋巴结清扫治疗老年原发性胆囊癌的临床疗效、安全性、免疫指标及生存分析

The efficacy,safety,immune indicators and survival analysis of laparoscopic cholecystectomy combined with lymph node dissection in the treatment of elderly primary gallbladder cancer

目的分析腹腔镜下胆囊切除术(LC)联合淋巴结清扫治疗老年原发性胆囊癌的疗效、安全性和生存情况。方法选取2018年1月~2021年7月行开腹胆囊根治术联合淋巴结清扫的老年原发性胆囊癌59例为对照组,行LC联合淋巴结清扫的老年原发性胆囊癌59例为研究组,比较两组临床疗效、围手术期指标、T细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、生活质量(SF-36)。结果研究组近期治疗有效率和对照组比较,差异无统计学意义(94.0%VS 72.5%,χ^(2)=0.209,P=0.648)。研究组淋巴结清扫时间为(39.27±5.63)分钟、手术所用时间为(235.16±31.37)分钟,对照组分别为(35.61±4.75)分钟、(194.59±30.82)分钟,两组比较差异有统计学意义(P<0.05)。研究组术中出血量为(32.63±5.42)ml,首次排气时间为(3.18±0.72)天、肠胃功能恢复时间为(3.98±1.04)天、住院时间(6.24±1.25)天,对照组分别为(61.27±7.85)ml、(4.02±0.83)天、(4.65±1.18)天、(10.41±2.18)天,两组比较差异均有统计学意义(P<0.05)。研究组术后CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)分别为16.52%±5.24%、15.79%±3.83%和0.47%±0.11%,对照组分别为13.74%±4.30%、10.83%±3.14%和0.29%±0.05%,两组比较差异有统计学意义(P<0.05)。观察组术后1个月生活质量总评分(SF-36)为(90.86±3.75)分,对照组为(86.85±3.14)分,两组比较,差异有统计学意义(P<0.05)。研究组并发症发生率低于对照组(7.01%VS 23.73%,χ^(2)=4.627,P<0.05)。研究组中位生存时间为(13.8±1.50)个月,对照组为(12.5±1.25)个月,两组比较差异有统计学意义(P>0.05)。结论LC联合淋巴结清扫治疗老年原发性胆囊癌安全有效,不影响远期预后生存。

Objective To analyze the efficacy,safety,and survival of laparoscopic cholecystectomy(LC)combined with lymph node dissection in the treatment of elderly primary gallbladder cancer.Methods 59 elderly patients with primary gallbladder cancer who underwent open cholecystectomy combined with lymph node dissection from January 2018 to July 2021 were selected as the control group,and 59 elderly patients with primary gallbladder cancer who underwent LC combined with lymph node dissection were selected as the study group.The clinical efficacy,perioperative indicators,and T cell subsets were compared between the two groups CD4^(+)、CD4^(+)/CD8^(+)、Quality of life(SF-36).Results The difference in recent treatment effectiveness between the research group and the control group is relatively small,(94.0%VS 72.5%,χ^(2)=0.209,P=0.648).The time required for lymph node dissection was(39.27±5.63)min and surgery time was(235.16±31.37)min in the study group,which was longer than that in the control group[(35.61±4.75)min and(194.59±30.82)min(P<0.05)].In the study group,the intraoperative bleeding volume was(32.63±5.42)ml and first exhaust time was(3.18±0.72)d,gastrointestinal function recovery time was(3.98±1.04)d,and hospitalization time was(6.24±1.25)d,which were shorter than those in the control group[(61.27±7.85)ml,(4.02±0.83)d,(4.65±1.18)d,(10.41±2.18)d,respectively,(P<0.05)].After surgery,the levels of CD3^(+)(16.52%±5.24%),CD4^(+)(15.79%±3.83%),and CD4^(+)/CD8^(+)(0.47%±0.11%)in the study group were higher than those in the control group(13.74%±4.30%,10.83%±3.14%and 0.29%±0.05%)(P<0.05).One month after surgery,the total quality of life score(SF-36)of the observation group(90.86±3.75)was higher than that of the control group(86.85±3.14)(P<0.05).The incidence of complications in the study group was lower than that in the control group(7.01%VS 23.73%,χ^(2)=4.627,P<0.05).The median survival time of the study group was(13.8±1.50)months,which was significantly higher than that of the control group[(12.5±1.25)months,P>0.05].Conclusion LC combined with lymph node dissection is a safe and effective treatment for elderly primary gallbladder cancer,without affecting long-term prognosis and survival.