精准胆道外科手术治疗胆囊癌的近远期疗效研究

目的 研究精准胆道外科手术治疗胆囊癌的近远期疗效。方法 前瞻性分析陆军特色医学中心 2014年2月至2017年2月收治的胆囊癌患者104例，采用随机数字法将其分为对照组和观察组，每组52例。对照组接受胆囊癌传统经验式外科手术，观察组接受精准胆道外科理论引导下手术。比较两组患者的手术效果、术后恢复指标、并发症发生率。术后随访3 年，比较两组患者的1 年、2 年及3 年生存率，并绘制 Kaplan-Meier生存曲线。结果 观察组较对照组淋巴结清扫数目（23.48±7.20） vs（ 15.86±5.93），t=16.64， P＜0.001]和阳性淋巴结数目（9.94±3.50） vs（ 5.27±4.39），t=7.51，P＜0.001]更高，R0切除率（76.92% vs 36.54%，χ2=16.37，P＜0.001）、胆囊癌扩大根治术率（34.62% vs 11.54%，χ2=5.13，P=0.02）及联合胰十二指肠切除术率（17.31% vs 3.85%，χ2=4.98，P=0.02）更高，术后排气时间（1.05±0.38）d vs（ 1.93±0.46）d， t=5.39，P＜0.001]和首次下床活动时间（2.85±1.16）d vs（ 6.26±1.92）d，t=7.88，P＜0.001]均明显更早；并发症发生率（23.08% vs 30.77%，χ2=0.78，P=0.38）无统计学差异。观察组术后1 年（61.54% vs 40.38%， χ2=4.66，P=0.03）、2年（44.23% vs 19.23%，χ2=7.50，P＜0.001）及3年（26.92% vs 7.69%，χ2=6.72，P＜0.001）生存率比对照组高，中位生存时间（17.37±8.64）个月 vs（ 8.95±4.59）个月，t=14.96，P＜0.001]更长。结论 精准胆道外科手术有助于胆囊癌患者选取最佳术式，提高手术切除质量和R0切除率，并能有效控制手术并发症，从而延长患者术后生存期。

Study on the short-term and long-term curative effect of precision biliary surgery on gallbladder cancer

Objective To investigate the short-term and long-term effects of precision biliary surgery on gallbladder cancer. Methods Prospective analysis was conducted on 104 patients with gallbladder cancer admitted in Army Characteristic Medical Center from Feb. 2014 to Feb. 2017. Patients were randomly divided into Control group and Observation group, with 52 cases in each group. Patients in Control group underwent traditional empirical surgery for gallbladder cancer, while patients in the Observation group received precision biliary surgery for gallbladder cancer. The surgical effect, postoperative recovery index, and incidence of postoperative complications were compared between the two groups. Both groups were followed up for 3 years. The 1-year, 2-year and 3-year survival rates between the two groups were compared, and Kaplan-Meier survival curve was drawn. Results Compared with the Control group, the number of dissected lymph nodes (23.48±7.20) vs (15.86±5.93), t=16.64, P<0.001] and positive lymph nodes (9.94±3.50) vs (5.27±4.39), t=7.51, P<0.001] was significantly higher, R0 excision rate (76.92% vs 36.54%, χ2=16.37, P<0.001), the rates of extended radical mastectomy (34.62% vs 11.54%, χ2=5.13, P=0.02)and the combination with pancreaticoduodenectomy (17.31% vs 3.85%, χ2=4.98, P=0.02) were significantly higher in the Observation group. The postoperative exhaust time (1.05±0.38)d vs (1.93±0.46)d, t=5.39, P<0.001] and the first time to get out of bed (2.85±1.16)d vs (6.26±1.92)d, t=7.88, P<0.001] were significantly earlier. There was no significant difference in the rates of postoperative complications (23.08% vs 30.77%, χ2=0.78, P=0.38) between the two groups. The postoperative 1-year (61.54% vs 40.38%, χ2=4.66, P=0.03), 2-year (44.23% vs 19.23%, χ2=7.50, P<0.001), and 3-year (26.92% vs 7.69%, χ2=6.72, P<0.001) survival rates in the observation group were significantly higher than those in the Control group, and median survival time (MST) (17.37±8.64)months vs (8.95±4.59)months, t=14.96, P<0.001] was significantly longer in the Observation group. Conclusion Precision biliary surgery is helpful for patients with gallbladder cancer to select the best operation methods, which can improve the quality of resection and R0 resection rate, and can effectively control the postoperative complications, prolong the postoperative survival time of patients.