肝门部胆管癌全腹腔镜与开放根治性切除术的初步比较：一项单中心队列研究

Preliminary comparison of total laparoscopic and open radical resection for hepatic hilar cholangiocarcinoma a single-center cohort study.

作者信息

Xiong Fei, Peng Feng, Li Xu, Chen Yongjun

机构信息

Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

出版信息

Asian J Surg. 2023 Feb;46(2):856-862. doi: 10.1016/j.asjsur.2022.07.158. Epub 2022 Oct 4.

DOI:10.1016/j.asjsur.2022.07.158

PMID:36207210

Abstract

BACKGROUD

The aim was to compare perioperative outcomes of hilar cholangiocarcinoma (HCCA) radical resection performed through the laparoscopic route or by open surgery in single-center cohort study.

METHODS

A retrospective study included all patients undergoing HCCA radical resection in our center from January 2018 to November 2019. Short-term outcomes of patients with laparoscopic and open surgery were compared demographic characteristics, intraoperative and postoperative parameters and extent of resection.

RESULTS

Among 64 patients included, 34 were performed with laparoscopic route and 30 were with open surgery. Laparoscopic versus open group was associated with a longer operation duration [475.50(219.00-630.00) vs. 375.00(220.00-557.00) min, P = 0.031], similar intraoperative bleeding volume [300.00(50.00-3500.00) vs. 350.00(100.00-1500.00) ml, P = 0.426]. No significant differences in tumor diameter [2.00(1.50-3.00) vs. 2.00(1.50-3.00) cm, P = 0.965], the number of lymph nodes retrieved [9.50(6.00-15.00) vs. 8.50(5.00-12.00), P = 0.706], and resection margins (94.1% vs. 86.7%, P = 0.407) between the two approaches were found. The LOS [20.00(10.00-44.00) vs. 21.00(6.00-27.00) d, P = 0.622], bile leakage (23.5% vs. 26.7%, P = 0.781), and liver failure (8.80% vs. 6.70%, P>0.99) were similar in the two groups. There was one patient in open surgery group developing liver failure and finally expired.

CONCLUSION

The safety and radicality of laparoscopic resection for HCCA are similar to open surgery and can be technically improved by rational trocar distribution, total caudate lobectomy and appropriate cholangioenteric anastomosis strategy.

摘要

背景

在一项单中心队列研究中，旨在比较通过腹腔镜途径或开放手术进行肝门部胆管癌（HCCA）根治性切除的围手术期结果。

方法

一项回顾性研究纳入了2018年1月至2019年11月在本中心接受HCCA根治性切除的所有患者。比较了腹腔镜手术和开放手术患者的短期结果，包括人口统计学特征、术中及术后参数和切除范围。

结果

在纳入的64例患者中，34例行腹腔镜手术，30例行开放手术。腹腔镜组与开放手术组相比，手术时间更长[475.50（219.00 - 630.00）对375.00（220.00 - 557.00）分钟，P = 0.031]，术中出血量相似[300.00（50.00 - 3500.00）对350.00（100.00 - 1500.00）毫升，P = 0.426]。两组在肿瘤直径[2.00（1.50 - 3.00）对2.00（1.50 - 3.00）厘米，P = 0.965]、获取的淋巴结数量[9.50（6.00 - 15.00）对8.50（5.00 - 12.00），P = 0.706]和切缘（94.1%对86.7%，P = 0.407）方面未发现显著差异。两组的住院时间[20.00（10.00 - 44.00）对21.00（6.00 - 27.00）天，P = 0.622]、胆漏（23.5%对26.7%，P = 0.781）和肝衰竭（8.80%对6.70%，P>0.99）相似。开放手术组有1例患者发生肝衰竭并最终死亡。