胆囊切除联合肝组织楔形切除和区域淋巴结清扫治疗胆囊癌患者疗效研究*

doi:10.3969/j.issn.1672-5069.2022.04.036

摘要/Abstract

摘要： 目的总结采取胆囊切除联合肝组织楔形切除和区域淋巴结清扫治疗T1b期胆囊癌(GC)患者的疗效。方法 2011年8月～2016年8月我院收治的98例T1b期GC患者,其中53例观察组患者接受胆囊切除联合肝组织楔形切除和区域淋巴结清扫术治疗,另45例对照组患者单纯接受胆囊切除术治疗。采用视觉模拟评分法(VAS)评价术后疼痛。随访患者5年或至死亡。结果观察组术中出血量显著多于对照组【(208.3±20.2) mL对(185.7±19.4)mL】,术后胃肠功能恢复时间和住院时间分别为(27.5±5.8)h和(11.7±2.6)d,显著长于对照组【分别为(19.9±4.2)h和(9.4±2.1)d,P<0.05】;在术后24 h和72 h,观察组VAS评分分别为(4.5±0.8)分和(2.1±0.7)分,与对照组的(4.4±0.9)分和(2.0±0.6)分比,无显著性差异(P>0.05);术后观察组胆囊窝积液、胃潴留、腹腔内出血、胆漏和腹腔感染等发生率为15.1%,对对照组的9.3%比,无显著性差异(P>0.05);随访6个月～5年,观察组1 a、3 a和5 a累积生存率分别为96.2%、81.1%和67.9%,对照组分别为91.1%、73.3%和55.6%,其中观察组5 a累积生存率显著高于对照组(Log-Rank x²=4.521,P=0.034)。结论采用胆囊切除联合肝组织楔形切除和区域淋巴结清扫治疗T1b期GC患者的疗效较好,可提高远期生存率。

关键词: 胆囊癌, 胆囊切除, 肝组织楔形切除, 区域淋巴清扫术, 治疗

Abstract: Objective The aim of this study was to summarize the long-term survival of patients with stage T1b gallbladder cancer (GC) after cholecystectomy and wedge resection of liver tissues and regional lymph node dissection (LND) combination therapy. Methods A total of 98 patients with stage T1b GC were encountered in our hospital between August 2011 and August 2016, and 53 in observation group received cholecystectomy and wedge resection of liver tissues and LND therapy and another 45 patients received cholecystectomy only therapy. All patients were followed-up for five years or to death. The postoperative pain was assessed by visual analogue scale (VAS). Results The intraoperative blood loss in the observation group was greater than that in the control group [(208.3±20.2) mL vs. (185.7±19.4) mL], the postoperative recovery time of gastrointestinal functions and hospitalization stay were longer than those in the control group [(27.5±5.8) h and (11.7±2.6) d vs. (19.9±4.2) h and (9.4±2.1) d, respectively, P<0.05]; at 24 h and 72 h post-operationally, the VAS score in the observation group was (4.5±0.8) and (2.1±0.7), not significantly different compared to (4.4±0.9) and (2.0±0.6) in the control (P>0.05); post-operationally, the complications such as cystic fossa effusion, gastric retention, intraperitoneal hemorrhage, bile leakage and peritoneal infections in the observation group was 15.1%, not significantly different as compared to 9.3% in the control (P>0.05); the one-year, three-year and five-year survival rates in the observation group were 96.2%, 81.1% and 67.9%, while in the control group were 91.1%, 73.3% and 55.6%, with the five-year survivals significantly different (Log-Rank x²=4.521, P=0.034). Conclusion The combination of cholecystectomy and wedge resection of liver tissues and regional LND is efficacious in dealing with patients with stage T1b GC, which could improve long-term prognosis.

Key words: Gallbladder cancer, Cholecystectomy, Wedge resection of liver tissues, Regional lymph node dissection, Therapy

邹吉, 陈晓波, 董仁华, 张浩. 胆囊切除联合肝组织楔形切除和区域淋巴结清扫治疗胆囊癌患者疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(4): 599-602.

Zou Ji, Chen Xiaobo, Dong Renhua, et al. Long-term survival of patients with stageT1b gallbladder cancer after cholecystectomy and wedge resection of liver tissues and regional lymph node dissection combination therapy[J]. Journal of Practical Hepatology, 2022, 25(4): 599-602.

参考文献

[1] Kim SH, Jung D, Ahn JH, et al. Differentiation between gallbladder cancer with acute cholecystitis: Considerations for surgeons during emergency cholecystectomy, a cohort study-science Direct. Int J Surg, 2017, 45(9):1-7.
[2] Cho JK, Lee W, Jang JY, et al. Validation of the oncologic effect of hepatic resection for T2 gallbladder cancer: A retrospective study. World J Surg Oncol, 2019, 17(1):8-8.
[3] Muszynska C, Lundgren L, Lindell G, et al. Predictors of incidental gallbladder cancer in patients undergoing cholecystectomy for benign gallbladder disease: Results from a population-based gallstone surgery registry. Surgery, 2017, 162(2):256-263.
[4] 刘鹏, 汤朝晖, 巩鹏, 等.不同手术方式治疗T1b期胆囊癌效果的多中心研究. 中华外科杂志, 2018, 56(5):355-359.
[5] 中华医学会外科学分会胆道外科学组. 胆囊癌诊断和治疗指南(2015年版). 临床肝胆病杂志, 2016, 32(3):411-419.
[6] 李国明, 孙文兵, 柯山,等. 射频消融处理胆囊床在T1b期胆囊癌根治性手术中的应用. 中华肝胆外科杂志, 2020, 26(1):44-47.
[7] 陈晨, 张东, 王林, 等. 原发性胆囊癌根治术的临床疗效及预后分析. 中华消化外科杂志, 2019, 18(2):128-134.
[8] Ihnát P, Skácelíková E, Vávra P, et al. Novel strategy in the treatment of liver metastases - Hepatic resection combined with stereotactic body radiotherapy. Asian J Surg, 2020, 43(9):902-906.
[9] Gupta V, Chandra A, Hatimi H, et al. Management of post-cholecystectomy double trouble: bile duct injury with incidental gallbladder cancer. Indian J Surg, 2018, 81(3):1-5.
[10] Rosato V, Negri E, Bosetti C, et al. Gallbladder disease, cholecystectomy, and pancreatic cancer risk in the International Pancreatic Cancer Case-Control Consortium (PanC4). Eur J Cancer Prev, 2020, 29(5):408-415.
[11] Jin LM, Zhang YH, Zhang CW, et al. Is laparoscopic radical cholecystectomy an effective and safe approach for advanced gallbladder cancer? Hepatobiliary Pancreat Dis Int, 2020, 19( 3):203-204.
[12] Benson AB 3rd, Abrams TA, Ben-Josef E, et al. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw, 2009, 7(4):350-391.
[13] 张宇, 刘振文, 张晓峰, 等. 多术式联合治疗T1a期胆囊癌的疗效及安全性分析. 中华普外科手术学杂志:电子版, 2020, 14(3):233-236.
[14] Parasar K, Saluja SS, Varshney VK, et al. Early recurrence after laparoscopic radical cholecystectomy in a patient with gallbladder cancer. J Minim Access Surg, 2019, 15(1):74-76.
[15] Søreide K, Guest RV, Harrison EM, et al. Systematic review of management of incidental gallbladder cancer after cholecystectomy. Br J Surg, 2019, 106(1):32-45.
[16] Jang JY, Heo JS, Han Y, et al. Impact of type of surgery on survival outcome in patients with early gallbladder cancer in the era of minimally invasive surgery: oncologic safety of laparoscopic surgery. Medicine, 2016, 95(22):e3675.
[17] 段安琪, 杨发才, 薄志远, 等. 区域淋巴结清扫范围对T4期胆囊癌患者预后影响的多中心回顾性研究. 中华消化外科杂志, 2019, 18(2):135-139.
[18] Han HS, Yoon YS, Agarwal AK, et al. Laparoscopic surgery for gallbladder cancer: an expert consensus statement. Dig Surg, 2019, 36(1):1-6.
[19] Navarro JG, Kang I, Hwang HK, et al. Oncologic safety of laparoscopic radical cholecystectomy in pT2 gallbladder cancer: A propensity score matching analysis compared to open approach. Medicine, 2020, 99(20):e20039.
[20] Panebianco A, Laforgia R, Volpi A, et al. Predictive factors for incidental gallbladder cancer (IGBC) in patients undergoing cholecystectomy for presumed benign disease. A single-center experience. Ann Ital Chir, 2018, 89(6):118-127.
[21] 辛大平, 彭彬, 黄明, 等. 不同手术方式治疗早期胆囊癌患者的临床疗效及远期生存分析. 中华普外科手术学杂志:电子版, 2020, 14(3):241-243.
[22] Lundgren L, Muszynska C, Ros A, et al. Are incidental gallbladder cancers missed with a selective approach of gallbladder histology at cholecystectomy? World J Surg, 2018, 42(4):1092-1099.

胆囊切除联合肝组织楔形切除和区域淋巴结清扫治疗胆囊癌患者疗效研究^*

Long-term survival of patients with stageT1b gallbladder cancer after cholecystectomy and wedge resection of liver tissues and regional lymph node dissection combination therapy

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