摘要
目的探讨腹腔镜肝切除术治疗肝内胆管癌的临床疗效。方法采用回顾性横断面研究方法。收集2013年1月至2018年1月福建医科大学孟超肝胆医院(32例)及陆军军医大学第一附属医院(30例)收治的62例肝内胆管癌患者的临床病理资料;男35例,女27例;平均年龄为60岁,年龄范围为25~77岁。根据术前及术中探查情况选择行淋巴结清扫术,再根据肿瘤大小及位置选择行腹腔镜解剖性或非解剖性肝切除术。观察指标:(1)手术及术后恢复情况。(2)病理学检查结果。(3)随访及生存情况。采用门诊和电话方式进行术后随访,每3个月随访1次,了解患者无瘤生存和总体生存情况。随访时间截至2018年6月。正态分布的计量资料以Mean±SD表示,偏态分布的计量资料以M(范围)表示,计数资料以绝对数或百分比表示。采用Kaplan-Meier法绘制生存曲线并计算生存率。结果(1)手术及术后恢复情况:62例患者均成功行腹腔镜肝肿瘤切除术,无中转开腹,无围术期死亡。62例患者中,40例行解剖性肝切除术、22例行非解剖肝切除术;18例患者同时行区域淋巴结清扫。62例患者手术时间为(217±86)min;12例患者术中行Pringle法入肝血流阻断,总阻断时间为(14±7)min,45例患者行选择性入肝血流阻断,5例患者未行肝门阻断;术中出血量为282mL(20~2500mL),4例患者术中输注悬浮红细胞;术后下床活动时间为1d(1~3d),术后首次肛门排气时间为2.5d(2.0~4.0d),术后拔除腹腔引流管时间为(4.4±1.3)d,术后患者肝功能恢复至接近正常水平时间为(6.8±1.6)d,无肝衰竭发生。62例患者中,6例发生术后并发症,包括胸腹腔积液5例,腹腔感染3例,肺部感染2例,胆瘘2例,腹腔内出血1例,尿潴留1例,术后切口感染1例,同一患者可合并多种并发症;Clavien-Dindo分级Ⅲ级并发症2例,予对症治疗后均好转;其余患者均未出现明显并发症。62例患者术后住院时间为(13±9)d。术后13例
Objective To investigate the clinical efficacy of laparoscopic hepatectomy for intrahepatic cholangiocarcinoma(ICC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 62 patients with ICC who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University(32 patients)and the First Hospital Affiliated to Army Medical University(30 patients)between January 2013 and January 2018 were collected;there were 35 males and 27 females,aged from 25 to 77 years,with an average of 60 years.According to the preoperative and intraoperative situations,lymph node dissection was performed,and anatomical or non-anatomical laparoscopic hepatectomy were performed based on tumor size and location.Observation indicators:(1)surgical and postoperative recovery;(2)pathological examination results;(3)follow-up and survival situations.Follow-up was conducted by telephone interview and outpatient examination once every 3 months to detect tumor-free survival and overall survival of patients up to June 2018.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute number and percentage.The survival curve and rate were drawn and calculated by the Kaplan-Meier method.Results(1)Surgical and postoperative recovery:all the 62 patients received successful laparoscopic hepatectomy,without conversion to open surgery or preoperative death,including 40 with anatomical hepatectomy and 22 with non-anatomical hepatectomy.There were 18 patients undergoing regional lymph node dissection.The operation time of 62 patients was(217±86)minutes.Of 62 patients,12 had hepatic vascular occlusion using the Pringle method with a total occlusion time of(14±7)minutes,45 received selective hepatic vascular occlusion and 5 did not receive hepatic portal occlusion.The volume of intraoperative blood loss was 282 mL(range,20-2 500 mL).Four patients had intraoperative infusion of suspended red blood
作者
罗柳平
李建伟
曹利
林科灿
罗顺峰
曾永毅
Luo Liuping;Li Jianwet;Cao Li;Lin Kecan;Luo Shunfeng;Zeng Yongyi(Department of Hepatobiliary Surgery,Mengchao Hepatobiliary Hospital Of Fujian Medical University,Fuzhou 350002,China;Department of Hepatobiliary Surgery,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2019年第2期169-175,共7页
Chinese Journal of Digestive Surgery
基金
吴阶平医学基金(LDWJPMF-102-17007)
福建省医学创新课题(2018-CX-49).
关键词
胆道肿瘤
肝内胆管癌
肝切除
淋巴结清扫
术后并发症
腹腔镜检查
Biliary tract neoplasms
Intrahepatic cholangiocarcinoma
Hepatectomy
Lymph node dissection
Postoperative complications
Laparoscopy
