【摘要】 目的比较联合全尾状叶切除与联合部分尾状叶切除的肝门部胆管癌根治术的安全性及远期疗效。方法回顾性分析2014年7月至2018年4月中山大学附属第一医院行联合尾状叶切除的33例肝门部胆管癌根治术患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男23例,女10例;年龄29～77岁,中位年龄60岁。采用倾向得分匹配法(PSM)将患者以1∶1分为全尾状叶切除组及部分尾状叶切除组,比较两组患者的近期及远期疗效。两组并发症发生率比较采用Fisher确切概率法,手术时间比较采用Mann-Whitney U检验。生存分析采用Kaplan-Meier法和Log-rank检验。结果 PSM后全尾状叶切除与部分尾状叶切除组各13例。全尾状叶切除组手术时间中位数为390(170)min,明显长于部分尾状叶切除组的300(63)min(Z=2.722,P<0.05)。全尾状叶切除组术后发生并发症8例,部分尾状叶切除组3例,差异无统计学意义(P=0.111)。全尾状叶切除组1、3、5年总体生存率分别为83.1%、44.3%、44.3%,部分尾状叶切除组相应为67.7%、25.4%、25.4%,差异无统计学意义(χ~2=0.986,P>0.05)。全尾状叶切除组1、3、5年无复发生存率分别为63.6%、27.3%、27.3%,部分尾状叶切除组相应为57.7%、28.8%、14.4%,差异亦无统计学意义(χ~2=0.004,P>0.05)。结论在肝门部胆管癌根治术中,与联合部分尾状叶切除相比,全尾状叶切除增加手术时间,但两者术后并发症发生率及长期生存并无明显差异。更多还原

【Abstract】 Objective To compare the safety and long-term efficacy between combining total caudate lobotomy and combining partial caudate lobotomy of hilar cholangiocarcinoma radical resection.Methods Clinical data of 33 patients with hilar cholangiocarcinoma who underwent radical resection of hilar cholangiocarcinoma combined with caudate lobotomy in the First Affiliated Hospital of Sun Yat-sen University from July 2014 to April 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,23 patients were male and 10 female,aged from 29 to 77 years,with a median age of 60 years.All patients were divided into the total and partial caudate lobotomy groups with a ratio of 1∶1 by propensity score matching (PSM).The short-and long-term clinical efficacy was statistically compared between two groups.The incidence of complications between two groups was compared by Fisher’s exact probability test.The operation time was compared by Mann-Whitney U test.Survival analysis was conducted by Kaplan-Meier method and Log-rank test.Results After PSM,13 patients were assigned into the total caudate lobotomy group and 13 cases into the partial caudate lobotomy group.In the total caudate lobotomy group,the median operation time was 390(170) min,significantly longer than 300(63) min in the partial caudate lobotomy group (Z=2.722,P<0.05).In the total caudate lobotomy group,8 patients developed postoperative complications and 3 cases in the partial caudate lobotomy group,and no statistical significance was noted between two groups (P=0.111).In the total caudate lobotomy group,the 1-,3-,5-year overall survival rates were 83.1%,44.3%,44.3%,and 67.7%,25.4%,25.4% correspondingly in the partial caudate lobotomy group,and no statistical significance was observed between two groups (χ~2=0.986,P>0.05).In the total caudate lobotomy group,the 1-,3-,5-year recurrence-free survival rates were 63.6%,27.3%,27.3%,and 57.7%,28.8%,14.4% in the partial caudate lobotomy group,and no statistical significance was found between two groups (χ~2=0.004,P>0.05).Conclusions Compared with combining partial caudate lobotomy,combining total caudate lobotomy will prolong the operation time in radical resection of hilar cholangiocarcinoma.Nevertheless,the incidence of postoperative complications and long-term survival do not significantly differ between two operations.更多还原