腹腔镜与开腹肝门部胆管癌根治术的对比研究

目的:对比腹腔镜肝门部胆管癌根治术与开腹肝门部胆管癌根治术的临床疗效,探讨腹腔镜肝门部胆管癌根治术的安全性及可行性。方法:回顾分析2011年3月至2013年10月收治的19例肝门部胆管癌患者的临床资料,术前根据患者及家属的要求,14例行四孔法腹腔镜肝门部胆管癌根治术(A组),5例行开腹肝门部胆管癌根治术(B组),对比分析两组患者术中及术后情况。结果:患者均完成相应术式。A组中12例于腹腔镜下使用吻合器完成肠间吻合;2例先扩大右上腹小切口于腹外完成肠间吻合后还纳腹腔,重新建立气腹完成胆肠吻合;1例Ⅳ型患者未达到完全根治。A组手术时间长于B组,差异有统计学意义(P<0.05),术后镇痛时间、住院时间短于B组,差异有统计学意义(P<0.05);术中出血量、术中淋巴结清扫数量、术后进食时间、术后并发症及住院总费用两组相比差异无统计学意义(P>0.05)。术后随访5~30个月,平均(17.6±0.8)个月,无一例死亡。结论:腹腔镜肝门部胆管癌根治术由腹腔镜技术熟练及手术经验丰富的手术团队开展是安全、可行的,具有患者创伤小、痛苦少、康复快、并发症少、美容效果好等优点。

The comparative study of laparoscopic and open radical operation for hilar cholangiocarcinoma

Objective：To compare the clinically therapeutic effect of laparoscopic and open radical resection for hilar cholan- giocarcinoma, and evaluate the feasibility and safety of laparoscopic radical resection for hilar cholangiocarcinoma. Methods：The clini- cal data of 19 patients who underwent radical resection for hilar cholangiocarcinoma from Mar. 2011 to Oct. 2013 were reviewed and an- alyzed with intraoperative and postoperative conditions retrospectively. They were divided into 2 groups, the laparoscopic group （group A ,n = 14 ） and the open group （group B, n = 5 ）. Results：All operations were completed successfully in 19 patients. 12 patients of group A underwent laparoscopic intestinal anastomosis using anastomat. 2 patients of group A underwent the surgical proceeding as following：enlarging the right upper quadrant incision and completing intestinal anastomosis outside the abdomen, then rebuilding pneumo- peritoneum and completing bilioenteric anastomosis. 1 patient diagnosed as type-IV hilar cholangiocarcinoma did not achieve a radical cure. The mean operation time of group A was longer than group B （ P 〈 0.05 ）. The mean time of postoperative analgesia and length of hospital stay of group A were shorter than group B （ P 〈 0.05 ）. There were no statistical differences between 2 groups in blood loss, harvested lymph nodes, gastrointestinal function recovery, postoperative complications and total hospitalization cost. No death occurred in follow-up of （ 17.6 ± 0.8） months （ range,5-30 months）. Conclusions： Laparoscopic radical resection for hilar cholangiocarcinoma is a feasible and safe surgical procedure carried out by a experienced surgical team, and has many advantages such as little trauma and pain, fast recovery, few complications and good cosmetic results.