摘要
目的探讨三维重建指导下腹腔镜右半肝加尾状叶切除治疗Bismuth Ⅲa型肝门部胆管癌(HCCA)的临床效果。方法回顾性分析2018年1月至2020年12月62例Bismuth Ⅲa型HCCA患者临床资料,按术前是否采用三维重建将患者分为对照组(行腹腔镜右半肝加肝尾状叶切除术)和研究组(三维重建指导下行腹腔镜右半肝加肝尾状叶切除术),每组各31例。数据应用软件SPSS 22.0处理。围手术期相关指标、肝功能指标等计量资料采用(x±s)表示,组间比较行独立样本t检验,组内比较行配对t检验;术后并发症等计数资料行χ^(2)检验。生存分析采用Kaplan-Meier法并行Log-Rank检验。P<0.05为差异有统计学意义。结果研究组患者手术时间、术中出血量、术后拔管时间、肛门排气时间及术后住院时间均显著低于对照组(P<0.05);两组患者肝脏切除体积比较差异无统计学意义(P>0.05)。术后两组患者TBIL、AST及ALT水平较术前均显著升高(P<0.05),且研究组上述各项指标均显著低于对照组(P<0.05)。研究组患者术后并发症的总发生率较对照组显著降低(16.1% vs. 38.7%,P<0.05)。随访期间,通过Kaplan-Meier分析显示,两组累积总生存率(71.0% vs. 80.6%)及无病生存率(67.7% vs. 77.4%)比较,差异均无统计学意义(Log-Rank χ^(2)=2.042、1.435,P=0.153、0.231)。结论三维重建指导下腹腔镜右半肝加尾状叶切除治疗Bismuth Ⅲa型HCCA不仅能够缩短手术时间,减少术中损伤,加快术后恢复,而且还对肝功能具有一定的保护作用,并可有效降低术后并发症的发生,确保了手术的精准性和安全性。
Objective To investigate the clinical effect of laparoscopic right half liver resection with caudate lobectomy under the guidance of three-dimensional reconstruction in the treatment of Bismuth Ⅲa hilar cholangiocarcinoma(HCCA).Methods A retrospective analysis was performed on 62 patients with Bismuth Ⅲa HCCA from January 2018 to December 2020. The patients were divided into control group and study group according to whether three-dimensional reconstruction was used before surgery,with 31 cases in each group. All patients underwent enhanced CT scan. The control group underwent laparoscopic right half liver resection with hepatic caudate lobectomy,and the study group underwent laparoscopic right half liver resection with hepatic caudate lobectomy with three-dimensional reconstruction guidance. The data was processed by SPSS 22.0. Perioperative indicators,liver function indicators and other measurement data were expressed by(x±s). Independent t test was performed for inter-group comparison and paired t test was performed for intra-group comparison. The statistical data of postoperative complications were χ^(2) test. Kaplan-Meier method and Log-rank test were used for survival analysis. P<0.05 was considered statistically significant.Results The operative time,intraoperative blood loss,postoperative extubation time,anal exhaust time and postoperative hospitalization time of the study group were significantly lower than those of the control group(P<0.05). There was no significant difference in liver resection volume between the two groups(P>0.05). After surgery,the levels of TBIL,AST and ALT in both groups were significantly higher than those before surgery(P<0.05),and all liver function indexes in the study group were significantly lower than those in the control group(P<0.05). The total incidence of postoperative complications in the study group was significantly lower than that in the control group(16.1% vs. 38.7%,P<0.05). During follow-up,Kaplan-Meier analysis showed that there was no significant difference
作者
唐浩
梁平
徐小江
曾凯
文拨辉
Hao Tang;Ping Liang;Xiaojiang Xu;Kai Zeng;Pohui Wen(Department of Cardiothoracic Hepatobiliary Surgery,928th Hospital of PLA Joint Logisttcs Support Force,Haikou Hainan Province 571159,China;Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)
出处
《中华普外科手术学杂志（电子版）》
2023年第6期688-692,共5页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
军队医学科技青年培育计划(18QNPO12)。
关键词
肝门部胆管癌
三维重建
腹腔镜
肝切除术
疗效比较研究
Hilar Cholangiocarcinoma
Three-Dimensional Reconstruction
Laparoscopes
Hepatectomy
Comparative Effectiveness Research
