摘要
目的 初步分析腹腔镜手术与开腹手术治疗肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)的疗效.方法 回顾性分析我科2010 年9 月～2023 年3 月84 例ICC接受手术治疗的临床资料,腹腔镜组45 例,开腹组39 例,通过倾向性评分匹配,最终34 对数据成功匹配,比较2 组手术时间、术中出血量、清扫≥6 枚淋巴结比例、R0 切除率、并发症、术后住院时间、生存率及复发等.结果 腹腔镜组术中出血量明显少于开腹组(中位数:250 ml vs.750 ml,Z=-3.406,P=0.001);腹腔镜组清扫≥6 枚淋巴结比例与开腹组比较差异无统计学意义(5.9%vs.17.6%,χ2=1.275,P=0.259);腹腔镜组与开腹组R0 切除率差异无显著性[88.2%(30/34)vs.82.4%(28/34),χ2=0.469,P=0.493].腹腔镜组总并发症发生率 17.6%(6/34),显著低于开腹组47.1%(16/34)(χ2=6.719,P=0.010);2 组严重并发症率均为2.9%(χ2=0.000,P=1.000).腹腔镜组术后住院时间明显缩短(中位数:7 d vs.10 d,Z=-3.021,P=0.003).腹腔镜组中位总生存期60.6 月,明显长于开腹组15.9 月(log-rank χ2=5.788,P=0.016);腹腔镜组中位无复发生存期26.4 月,明显长于开腹组7.6 月(log-rank χ2=4.532,P=0.033).结论 腹腔镜肝切除术治疗ICC具有出血量少、并发症发生率低、术后住院时间短、生存期延长等优势,R0 切除率、充分淋巴结清扫率与开腹手术相当.
Abstract
Objective To preliminarily analyze the efficacy of laparoscopic surgery versus open surgery in patients with intrahepatic cholangiocarcinoma(ICC).Methods A retrospective analysis was conducted on 84 patients with ICC who underwent surgical resection from September 2010 to March 2023,including 45 cases in the laparoscopic surgery group and 39 in the open surgery group.By using propensity score matching,34 matched pairs were successfully identified.The study compared intraoperative blood loss,proportion of achieving≥6 lymph nodes dissection,R0 resection rate,complication,postoperative hospital stay,survival,and recurrence between the two groups.Results In the laparoscopic group,intraoperative blood loss was significantly less than that in the open surgery group(median:250 ml vs.750 ml,Z=-3.406,P=0.001).The proportion of achieving≥6 lymph node dissection in the former was lower than that in the latter,but the difference was not statistically significant(5.9%vs.17.6%,χ2=1.275,P=0.259).There was no statistical difference in R0 resection rate between the laparoscopic group and the open surgery group[88.2%(30/34)vs.82.4%(28/34),χ2=0.469,P=0.493].The complication rate in the laparoscopic group was 17.6%(6/34),significantly lower than 47.1%(16/34)in the open surgery group(χ2=6.719,P=0.010);however,the rate of severe complication was the same in both groups at 2.9%(χ2=0.000,P=1.000).Laparoscopic surgery significantly shortened the postoperative hospital stay(median:7 d vs.10 d,Z=-3.021,P=0.003).The median overall survival in the laparoscopic group was 60.6 months,significantly longer than 15.9 months in the open surgery group(log-rank χ2=5.788,P=0.016).The median recurrence-free survival was 26.4 months in the laparoscopic group,significantly longer than 7.6 months in the open surgery group(log-rank χ2=4.532,P=0.033).Conclusions Compared to open surgery,laparoscopic surgery for ICC offers advantages such as less blood loss,lower complication rate,shorter postoperative hospital stay and longer survival.It achieves comparable R0 resection rate and adequate lymph node dissection.
基金项目
科技创新2030-"新一代人工智能"重大项目(2020AAA0105004)
北京大学第三医院临床队列建设项目(BYSYDL2023005)
NETL
NSTL
万方数据