腹腔镜肝切除术与开腹肝切除术治疗肝内胆管细胞癌患者短期临床疗效研究*

目的 研究腹腔镜肝切除术(LH)与开腹肝切除术(OH)治疗肝内胆管细胞癌(ICC)患者的短期临床疗效。方法 2018年2月～2021年2月我院诊治的122例ICC患者,被随机分为对照组61例和观察组61例,分别接受OH或LH治疗,随访观察半年。采用ELISA法检测血清C反应蛋白(CRP)、皮质醇(Cor)和白细胞介素-6(IL-6)。结果 LH组手术时长、术中失血量、肛门首次排气和术后住院日分别为(232.2±50.4)min、(592.3±164.7)ml、(2.1±0.8)d和(6.5±1.3)d,显著短于或少于0H组【分别为(321.1±69.7)min、(995.5±321.4)ml、(2.7±0.7)d和(8.2±1.7)d,P＜0.0 5】;在术后3 d时,LH组血清CRP、Cor和IL-6水平分别为(25.1±4.0)mg/L、(529.6±75.4)mmol/L和(83.5±7.2)pg/ml,均显著低于0H组【分别为(39.8±5.1)mg/L、(654.7±78.1)mmol/L和(97.3±10.2)pg/ml,P＜0.05】;在术后7 d时,LH组血清AST水平为(155.2±12.7)U/L,显著低于0H组【(209.3±17.0)U/L,P＜0.05】;在术后30 d时,LH组不良事件发生率为11.5%,显著低于0H组的26.2%(P＜0.05);在术后随访半年时,LH组肿瘤复发率为3.3%,病死率为3.3%,与OH组的1.6%和4.9%比,差异无统计学意义(P＞0.05)。结论 采用LH治疗ICC患者可获得较好的手术效果,术后恢复快,可能与减轻了应急反应程度有关。

Comparison of laparoscopic hepatectomy and open hepatectomy in the treatment of patients with intrahepatic cholangiocarcinoma

Objective The aim of this study was to compare the clinical efficacy of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in the treatment of patients with intrahepatic cholangiocarcinoma (ICC). Methods 122 patients with ICC were enrolled in our hospital between February 2018 and February 2021, and were divided into control (n=61) and observation group (n=61), underwent OH or LH. All patients with ICC were followed-up for half a year. Serum C-reactive protein (CRP), cortisol (Cor) and interleukin-6 (IL-6) levels were detected by ELISA. Results The operation time, the intraoperative blood loss, the postoperative first anal exhaust time and the postoperative hospitalization time in patients receiving LH were (232.2±50.4)min, (592.3±164.7)ml, (2.1±0.8)d and (6.5±1.3)d, significantly shorter or less than (321.1±69.7)min, (995.5±321.4) ml, (2.7±0.7)d and (8.2±1.7)d, respectively, P＜0.0 5] in patients receiving OH; at the end of 3 days after operation, serum CRP, Cor and IL-6 levels in patients receiving LH were (25.1±4.0)mg/L,(529.6±75.4)mmol/L and (83.5±7.2)pg/ml, all significantly lower than (39.8±5.1)mg/L, (654.7±78.1) mmol/L and (97.3±10.2)pg/ml, respectively, P＜0.05] in patients receiving OH; at 7 days, serum AST level in patients with LH operation was (155.2±12.7)U/L, much lower than (209.3±17.0)U/L, P＜0.05] in patients with OH operation; at 30 days, the incidence of untoward effects in patient with LH operation was 11.5%, much lower than 26.2%(P＜0.05) in patients with OH operation; at the end of six month follow-up, there were no significant differences respect to the tumor recurrence and the mortality rates between the two groups (3.3% and 3.3% vs. 1.6% and 4.9%, respectively, P＞0.05). Conclusion The LH is a reasonable choice for patients with ICC, with a relative rapid recovery, which might be related to the mild inflammatory reactions.