【作者】 杨浩；

【导师】 秦兴雷；

【作者基本信息】 河南大学 ， 外科学（肝胆胰腺外科）（专业学位）， 2023， 硕士

【摘要】 目的:比较本中心开展的腹腔镜肝门部胆管癌根治术与开腹肝门部胆管癌根治术的围手术期结果以及近期临床疗效,进一步评估腹腔镜肝门部胆管癌根治术的可行性、有效性以及安全性,为促进腹腔镜肝门部胆管癌的临床推广提供支持。方法:本研究共纳入河南大学人民医院肝胆胰腺外科在2017年1月-2021年12月期间收治的103例肝门部胆管癌患者的临床资料,根据其手术方式选择的不同将其分为腹腔镜组(n=50)和开腹组(n=53)。比较两组患者在术前一般资料、术中资料、术后资料、术后肿瘤学结果以及随访生存情况之间的不同。结果:(1)术前一般资料:两组间年龄、性别、总胆红素、肿瘤标志物、胆道引流情况、合并基础疾病情况、Bismuth分型、Child-Pugh分级等指标对比无统计学差异(均P>0.05)。(2)术中资料:腹腔镜组手术时间400(144)min长于开腹组325(124)min,差异具有统计学意义(P<0.01);腹腔镜组术中出血量为300(163)ml,开腹组为400(200)ml,两组对比差异具有统计学意义(P<0.05);术中输血情况对比,腹腔镜组术中输血率38%(19/50),开腹组术中输血率49.06%(26/52),两组对比尚未出现差异(P>0.05)。(3)术后并发症对比:腹腔镜组总体并发症发生率为34%,包含胆瘘1例,术后出血3例,肺部感染13例,腹腔感染13例以及切口感染12例,开腹组总体并发症发生率为47.20%,包含上消化道出血2例,胆漏3例,术后出血8例,肺部感染16例,腹腔感染18例以及切口感染18例,术后并发症发生率两组之间差异均无统计学意义(P>0.05)。(4)术后恢复情况:腹腔镜组与开腹组术后排气时间分别为2(1)天vs4(2)天,术后流质饮食时间分别为3(1)天vs4(2)天、术后下床时间分别为3(1)天vs4(2)天,腹腔镜组均短于开腹组,差异具有统计学意义(P<0.01)。两组住院时间18(2)天vs23(2)天,差异具有统计学意义(P<0.01)(5)术后肿瘤学结果:两组在肿瘤的病理分化程度、TNM分期、血管侵犯、淋巴结转移等方面对比均无差异(均P>0.05)。(6)随访情况:腹腔镜组术后1、2年累计生存率分别为82%、65%,开腹组术后1、2年累计生存率分别为84%、64%,组间差异无统计学意义(P>0.05)。结论:对符合适应症的患者来说,腹腔镜下肝门部胆管癌根治术是一种有效的、安全的、可行的方法,可以达到不亚于开腹手术的临床疗效,可减少术中出血,使患者术后排气时间、术后流质饮食时间、术后下床活动时间提前,并缩短患者的术后住院时间,临床疗效良好并且在促进患者快速康复方面具有一定优势。更多还原

【Abstract】 Objective: The aim of this study was to compare the perioperative results and recent clinical outcomes of laparoscopic radical resection of hilar cholangiocarcinoma and open radical resection of hilar cholangiocarcinoma(LRRHC and ORRHC),to further evaluate the feasibility and safety of LRRHC,and to provide support for promoting the clinical application of LRRHC.Methods: A retrospective study included 103 patients undergoing HCCA radical resection in the People’s Hospital of Henan University from January 2017 to December 2021.Based on the different surgical approaches taken,50 patients were divided into the laparoscopic surgery group and 53 patients in the open surgery group and the differences between the two groups were compared in terms of preoperative general data,intraoperative data,postoperative data,postoperative oncological outcomes,and follow-up survival.Results:(1)Preoperative general data: There were no statistically significant differences between the two groups in age,gender,total bilirubin,tumor markers,bile duct drainage,combined underlying diseases,Bismuth type and Child-Pugh classification(all P > 0.05).(2)Intraoperative data: the operative time was longer in the laparoscopic surgery group 400(144)min than in the open surgery group 325(124)min,with statistically significant differences(P < 0.01).Intraoperative bleeding was 200.00(700.00)ml in the laparoscopic surgery group and 300.00(400.00)ml in the open surgery group,and the difference between the two groups was not yet statistically significant(P > 0.05).The intraoperative blood transfusion rate was 38.00%(19/50)in the laparoscopic surgery group and 49.06%(26/53)in the open surgery group,and the difference between the two groups was not yet statistically significant(P > 0.05).(3)Comparison of postoperative complications: The overall complication rate in the laparoscopic surgery group was36.00%,including 1 cases of biliary fistula,3 cases of postoperative bleeding,13 cases of pulmonary infection,6 cases of abdominal infection and 12 cases of incisional infection.While the overall complication rate in the open surgery group was 30.68%,including 2 cases of upper gastrointestinal bleeding,3 cases of biliary fistula,8 cases of postoperative bleeding,16 cases of pulmonary infection,18 cases of abdominal infection and 18 cases of incisional infection.The difference in the incidence of postoperative complications between the two groups except abdominal infection was not statistically significant.(4)Postoperative recovery: the postoperative first exhaust time was 1(1)d vs.4(2)d,the postoperative oral feeding time was 3(1)d vs.4(2)d,the time to getting out of bed after surgery was 3(1)d vs.4(2)days,laparoscopic surgery were shorter than those in the open group,and the differences were statistically significant(P < 0.01).The hospitalization time was 18(2)d vs.23(2)d in the two groups,and the differences were statistically significant(P > 0.05).(5)Postoperative oncological results: There was no difference in the degrees of pathological differentiation and TNM staging、venous invasion and lymph node metastasis between the remaining two groups(all P >0.05).The deadline for follow-up was June 2022.The 1-year and 2-year cumulative survival rates in the laparoscopic surgery group were 82%and 65% respectively,and those in the open group were 84% and 64% respectively.There was no significant difference between the groups(P>0.05).Conclusion:For patients who meet the indications,Laparoscopic radical resection of HCCA has comparable perioperative safety compared to open surgery group,which can achieve clinical efficacy no less than open surgery.Laparoscopic radical resection of HCCA can advance the postoperative first exhaust time,the postoperative oral feeding time and time to get out of bed,and has certain advantages in promoting rapid recovery of patients.更多还原