腹腔镜肝门部胆管癌根治性切除术的临床疗效分析

Clinical efficacy analysis of laparoscopic radical resection of hilar cholangiocarcinoma

目的分析腹腔镜肝门部胆管癌(HCCA)根治性切除术的可行性与安全性。方法回顾性分析2019年1月至2022年1月于西安交通大学第一附属医院肝胆外科行根治性手术切除的72例HCCA患者的临床资料,其中男性36例,女性36例,年龄57(47,63)岁。根据手术方式分为腹腔镜组39例和开腹组33例。比较两组患者的手术安全性、肿瘤根治性、术后恢复情况、并发症及生存时间等指标。结果腹腔镜组与开腹组在手术时间上差异无统计学意义[(6.4±2.6)h比(6.3±2.4)h,P>0.05],但腹腔镜组出血量低于开腹组[(531.9±273.3)ml比(674.6±330.0)ml],差异有统计学意义(t=2.01,P=0.049)。腹腔镜组与开腹组在R 0切除率[92.3%(36/39)比93.9%(31/33)]、淋巴结清扫数量[(7.7±2.6)个比(7.6±2.4)个]及术后并发症发生率[20.5%(8/39)比18.2%(6/33)]方面差异无统计学意义(均P>0.05)。但腹腔镜组在术后镇痛时间[(2.0±0.7)d比(2.8±0.9)d]、术后恢复进食时间[(1.6±0.5)d比(3.9±0.9)d]及术后住院时间[(8.6±1.5)d比(12.8±2.2)d]方面均优于开腹组,差异均有统计学意义(t=4.04、8.23、9.47,均P<0.001)。腹腔镜组和开腹组的术后累积生存率比较差异无统计学意义(χ^(2)=0.50,P=0.480)。结论腹腔镜HCCA根治术与开腹手术具有相近的疗效,且具有创伤小、康复快的优势。

ObjectiveTo analyze the feasibility and safety of laparoscopic radical resection of hilar cholangiocarcinoma(HCCA).MethodsClinical data of 72 patients with HCCA undergoing radical resection at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to January 2022 were retrospectively analyzed,including 36 males and 36 females,aged 57(47,63)years old.According to surgical approach,patients were divided into the laparoscopic group(n=39)and open group(n=33).The surgical safety,tumor radicality,postoperative recovery,complications and survival time were compared between the two groups.ResultsOperative time was comparable between the two groups[(6.4±2.6)h vs.(6.3±2.4)h,P>0.05],while the intraoperative blood loss was lower in the laparoscopic group[(531.9±273.3)ml vs.(674.6±330.0)ml].Data were also comparable between the two groups in terms of R0 resection rate[92.3%(36/39)vs.93.9%(31/33)],the number of lymph node dissection(7.7±2.6 vs.7.6±2.4),and the incidence of postoperative complications[20.5%(8/39)vs.18.2%(6/33)](all P>0.05).However,the laparoscopic group was superior to the open group in terms of postoperative analgesia time[(2.0±0.7)d vs.(2.8±0.9)d],postoperative resumption of feeding time[(1.6±0.5)d vs.(3.9±0.9)d],and postoperative hospitalization time[(8.6±1.5)d vs.(12.8±2.2)d](t=4.04,8.23,9.47,respectively,all P<0.001).Postoperative cumulative survival was comparable between the two groups(χ^(2)=0.50,P=0.480).ConclusionLaparoscopic radical resection of HCCA has similar efficacy to open surgery and has the advantage of less invasiveness and enhanced recovery.