Dou C W, Zhang C X, Liu J, Cheng J, Jin L M, Liu J W, Zhang C W
Department of Hepatopancreatobiliary Surgery & Minimally Invasive Surgery,Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310004, China.
Zhonghua Wai Ke Za Zhi. 2022 Feb 1;60(2):140-147. doi: 10.3760/cma.j.cn112139-20210226-00099.
To compare the short-term efficacy and long-term prognosis of laparoscopic and laparotomy radical resection for gallbladder cancer(GBC). From January 2010 to December 2020,the clinical data and survival information for 133 patients who underwent radical resection of GBC at the Department of Hepatopancreatobiliary Surgery,Zhejiang Provincial People's Hospital,were retrospectively collected. Eighty patients(23 males and 57 females) underwent laparoscopic radical resection and had a median age((IQR)) of 66.0(12.8)years(range:28.0 to 82.0 years). Fifty-three patients(45 males and 8 females) who received laparotomy were 63.0(6.0)years old(range:45.0 to 80.0 years old). There were no significant differences in age,gender,body mass index,preoperative albumin,preoperative total bilirubin,N stages,vascular invasion,peri-neural invasion or tumor differentiation between the laparoscopic and laparotomy group(all >0.05). But there were significant differences in preoperative CA19-9(=-2.955, =0.003), preoperative ALT level(=-2.801,=0.031) and T stage (χ=19.110,=0.007) between the two groups. A non-parametric test was used for quantitative data. χ test or Fisher exact probability method was used for count data. Patients in the laparoscopic group did not differ from those in the laparotomy group in terms of length of operation,number of lymph node yield,number of positive lymph nodes,the incidence of intraoperative gallbladder rupture,incidence of postoperative bile leakage,abdominal bleeding or abdominal infection,30-day mortality,90-day mortality, the incidence of incision implantation or peritoneal cavity metastasis(all >0.05). Patients in the laparoscopic group showed less intraoperative bleeding(100.0(200.0)ml 400.0(250.0)ml)(=-5.260,<0.01),fewer days with drainage tube indwelling(6.0(3.8)days 7.0(4.0)days)(=-3.351, =0.001), and fewer postoperative days in hospital(8.0(5.0)days 14.0(7.5)days)(=-6.079,<0.01) than those in the laparotomy group. Patients in the laparoscopic group displayed better overall survival (<0.01) and progression-free survival (<0.01). Subgroup analysis for GBC of T1b-T2 and T3 stages revealed comparable overall survival and progression-free survival between the laparoscopic and laparotomy groups (>0.05). Laparoscopic radical resection can achieve long-term survival for GBC comparable to that with open surgery. Laparoscopic radical resection has advantages over open surgery regarding surgical trauma and postoperative recovery.
比较腹腔镜与开腹根治性切除术治疗胆囊癌（GBC）的短期疗效和长期预后。回顾性收集2010年1月至2020年12月在浙江省人民医院肝胆胰外科接受GBC根治性切除术的133例患者的临床资料和生存信息。80例患者（男23例，女57例）接受腹腔镜根治性切除术，中位年龄（（四分位间距））为66.0（12.8）岁（范围：28.0至82.0岁）。53例接受开腹手术的患者年龄为63.0（6.0）岁（范围：45.0至80.0岁）。腹腔镜组与开腹组在年龄、性别、体重指数、术前白蛋白、术前总胆红素、N分期、血管侵犯、神经周围侵犯或肿瘤分化方面均无显著差异（均>0.05）。但两组术前CA19-9（=-2.955， =0.003）、术前ALT水平（=-2.801，=0.031）和T分期（χ=19.110，=0.007）存在显著差异。定量数据采用非参数检验。计数数据采用χ检验或Fisher确切概率法。腹腔镜组患者在手术时长、淋巴结清扫数量、阳性淋巴结数量、术中胆囊破裂发生率、术后胆漏发生率、腹腔出血或腹腔感染发生率、30天死亡率、90天死亡率、切口种植或腹腔转移发生率方面与开腹组无差异（均>0.05）。腹腔镜组患者术中出血较少（100.0（200.0）ml对400.0（250.0）ml）（=-5.260，<0.01），引流管留置天数较少（6.0（3.8）天对7.0（4.0）天）（=-3.351， =0.001），术后住院天数较少（8.0（5.0）天对14.0（7.5）天）（=-6.079，<0.01）。腹腔镜组患者的总生存期（<0.01）和无进展生存期（<0.01）更佳。对T1b-T2和T3期GBC的亚组分析显示，腹腔镜组与开腹组的总生存期和无进展生存期相当（>0.05）。腹腔镜根治性切除术可使GBC患者获得与开放手术相当的长期生存。腹腔镜根治性切除术在手术创伤和术后恢复方面优于开放手术。
