【摘要】 目的比较不同手术方式治疗早期胆囊癌的临床疗效。方法回顾性分析北京大学人民医院于2010年1月至2016年12月期间收治的43例早期胆囊癌(Tis~T2期)患者的临床资料,根据手术方式分为完全腹腔镜下胆囊切除(LC)+淋巴结清扫(LND)+射频消融(RA)组10例、开腹胆囊切除(OC)+LND+RA组18例,OC+LND+肝脏部分切除(LR)组15例。比较3组患者的手术时间、术中出血量、术后住院时间、术后并发症发生率及远期生存情况。结果 43例患者的手术均顺利,无围手术期死亡发生。(1)手术时间和术后住院时间:3组患者的手术时间和住院时间比较差异均有统计学意义(P<0.05)。与LC+LND+RA组比较,OC+LND+RA组和OC+LND+LR组的手术时间和术后住院时间均较长(P<0.017),但OC+LND+RA组和OC+LND+LR组间的手术时间和术后住院时间比较差异均无统计学意义(P>0.05)。(2)术中出血量:3组患者的术中出血量比较差异有统计学(P<0.001)。与OC+LND+LR组比较,LC+LND+RA组和OC+LND+RA组的术中出血量均较少(P<0.017),但LC+LND+RA组和OC+LND+RA组的术中出血量比较差异无统计学意义(P=0.172)。(3)术后并发症:3组患者的术后并发症发生率比较差异无统计学意义(P=0.326)。(4)远期生存情况。3组患者的生存曲线比较差异无统计学意义(P=0.057)。结论胆囊切除联合胆囊床RA对早期胆囊癌(Tis~T2期)可以达到根治效果,特别是LC+LND+RA较其他2种术式的手术时间更短,患者恢复更快。更多还原

【Abstract】 Objective To compare the clinical efficacy and safety of different surgical methods in the treatment of early-stage gallbladder carcinoma(GBC). Methods The clinical data of 43 patients with early-stage GBC who received treatment in Peking University People’s Hospital from Jan. 2010 to Dec. 2016 were retrospectively analyzed. According to the surgical methods, the patients were divided into laparoscopic cholecystectomy(LC)+lymph node dissection(LND)+radiofrequency ablation(RA) group, open cholecystectomy(OC)+LND+RA group, and OC+LND+liver resection(LA) group. Operation duration, intraoperative blood loss, postoperative hospital stay, surgical complications, and long-term survival were compared among the 3 groups. Results All the 43 patients performed successful surgery without perioperative death.(1) Operation duration and postoperative hospital stay. The differences of operation duration and postoperative hospital stay among the 3 groups were statistically significant(P<0.05). Compared with the LC+LND+RA group, operation duration and postoperative hospital stay of the OC+LND+RA group and the OC+LND+LR group were longer(P<0.017), but there was no statistically significant difference between the OC+LND+RA group and the OC+LND+LR group(P>0.017).(2) Intraoperative blood loss. The difference of intraoperative blood loss among the 3 groups was statistically significant(P<0.001). Compared with the OC+LND+LR group, the intraoperative blood loss was lower in the LC+LND+RA group and the OC+LND+RA group(P<0.017), but there was no significant difference between the LC+LND+RA group and the OC+LND+RA group(P=0.172).(3) Postoperative complications. There was no significant difference in the incidence of postoperative complications among the 3 groups(P=0.326).(4) Long-term survival. There was no significant difference in survival curves among the 3 groups(P=0.057). Conclusions The method of cholecystectomy combined with LND and RA of gallbladder bed can achieve the radical effect on early-stage GBC(Tis–T2). Laparoscopic surgery, in particular, has shorter operation duration and faster recovery.更多还原