中国实用外科杂志

中国实用外科杂志

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精准胆道外科技术与传统手术治疗胆囊癌临床疗效对比研究

李茂岚，朱逸荻，吴向嵩，包润发，束弈俊，张    飞，顾    钧，龚    伟，刘颖斌   

  1. 上海交通大学医学院附属新华医院普外科 上海市胆道疾病重点实验室，上海200092
  • 出版日期:2018-09-01 发布日期:2018-09-07

  • Online:2018-09-01 Published:2018-09-07

摘要：

目的    探讨精准胆道外科理论和技术在手术治疗中的应用及其价值。方法    回顾性分析2000年1月至2015年6月上海交通大学医学院附属新华医院收治的97例胆囊癌病人资料。按照收治的时间将病人分为传统手术组（38例，2000年1月至2010年12月）与精准手术组（59例，2011年1月至2015年6月）。比较两组病人的围手术期状况及生存期等指标。结果    两组病人在术前年龄、性别、分化程度、TNM分期、白蛋白、CA19-9、术中出血量、术后住院天数等方面差异均无统计学意义。精准手术组行胆囊癌扩大根治术比例为35.5%（21/59），传统手术组为15.6%（6/38），两组比较差异有统计学意义（χ2=4.513，P<0.05）。精准手术组R0切除率为66.1%，淋巴结清扫数目（26.0±12.1）枚；传统手术组R0切除率为18.4%，淋巴结清扫数目（17.0±9.1）枚，两组比较差异有统计学意义(χ2=21.075，P<0.001；t=3.915，P<0.001）。精准手术组病人的中位生存期19.2个月，1、3年存活率分别为62.7%、28.8%；传统手术组病人的中位生存期9.9个月，1、3年存活率分别为42.1%、7. 9%，差异有统计学意义（χ2=3.960，6.180，P<0.05）。而两组术中出血量、并发症发生率、住院时间等差异均无统计学意义。结论  精准胆道外科理论和技术在胆囊癌病人中的应用，可有效提高根治性手术切除率和术后病人的存活率。

关键词: 胆囊癌, 精准外科, 并发症

Abstract:

Comparative study of clinical efficacy of precision biliary surgical technique and traditional surgery for gallbladder carcinoma        LI Mao-lan, ZHU Yi-di, WU Xiang-song, et al. Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Corresponding author：LIU Ying-Bin，E-mail：laoniulyb@163.com
Abstract    Objective    Discuss the value and clinical applications of precise biliary surgery theory and technology in gallbladder tumor resection.Methods    The clinical data of 97 patients with gallbladder cancer who received radical cholecystectomy in XingHua Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to June 2015 were retrospectively analyzed．All the patients were divided into 2 groups，38 patients who were admitted from January 1986 to December 2006 were in the traditional surgery group，and 59 patients who were admitted from January 2011 to June 2015 were in the precision surgery group．The perioperative condition and prognosis of the patients in the 2 groups were compared．Results    There were no significant differences in the clinicopathological characteristics, such as gender, age, histological grade, the TNM stage, median volume of intraoperative blood loss and duration of postoperative hospital stay between the two groups. The ratios of extended radical operation were 35.5％(21/59)in the precision surgery group, and 15.6%(6/38)in the traditional surgery group，with significant difference between the 2 groups(χ2=4.513，P<0.05)．Patients in the precision surgery group had significantly higher R0 resection rate (66.1% vs. 18.4％, P＜0.05) and median dissected lymph node number (26.0±12.1 vs. 17.0±9.1, P＜0.05).The median survival time was 19.2 months in patients in the precision surgery group，and the 1- and 3- year survival rates of patients were 62.7%，28.8% respectively. The median survival time was 9.9 months in patients in the traditional surgery group，and the 1- and 3- year survival rates of patients were 42.1%、7.89% respectively. There was a significant difference between the 2 groups. The differences of the median volume of intraoperative blood loss，complication rates，duration of postoperative hospital stay between the 2 groups were not statistically significant. Conclusion Application of the concept and techniques of precision biliary surgery significantly increase the radical resection rate and improve the therapeutic outcomes.

Key words: gallbladder cancer, precise surgery, complication