腹腔镜与开腹Bismuth-Ⅰ型肝门胆管癌根治术的疗效分析*

Analysis of laparoscopic and open radical resection for hilar cholangiocarcinoma of type Bismuth-I*

摘要:

摘要：目的  探讨腹腔镜与开腹行Bismuth-Ⅰ肝门胆管癌根治术的的临床效果。方法  回顾分析2011年1月－2017年1月在该院行开腹（24例）及腹腔镜（10例）手术治疗的34例Bismuth-Ⅰ型肝门胆管癌患者的临床资料。结果  两组患者均成功行Bismuth-Ⅰ型肝门胆管癌根治术，腹腔镜组患者平均术中出血量（179.50±98.05）ml和术后平均住院时间（11.80±2.49）d，明显低于开腹组的（261.25±97.33）ml和（16.25±3.35）d，差异有统计学意义（P <0.05）。腹腔镜组术后第1、3和5天的总胆红素（TBIL）分别为（102.20±45.49）、（83.57±30.66）和（45.09±18.41）mmol/L；开腹组术后第1、3和5天TBIL分别为（148.17±62.78）、（121.60±43.35）和（80.59±43.89）mmol/L，两组差异有统计学意义（P <0.05）。且腹腔镜组术后淋巴结检出数（9.79±3.05）枚、术后并发症1例、切缘阳性数0例；开腹组术后淋巴结检出数（9.30±3.06）枚，术后并发症3例，切缘阳性数0例，两组差异无统计学意义（P >0.05）。两组患者均获得6～18个月的随访，在随访期间两组患者均未见复发及转移。结论  腹腔镜下Bismuth-Ⅰ型肝门胆管癌根治术在淋巴结清扫、术后并发症、切缘阳性率和随访期间预后等方面与开腹Bismuth-Ⅰ型肝门胆管癌根治术效果相似，且更具微创优势。因此，腹腔镜下Bismuth-Ⅰ型肝门胆管癌根治术是安全、可行的手术方式。

Abstract:

Abstract: Objective To investigate the clinical effect of laparoscopic and open radical resection of hilar cholangiocarcinoma (Bismuth-I). Methods From January 2011 to January 2017, 34 patients (10 patients in the laparoscopic group and 24 patients in the open group) underwent radical resection of hilar cholangiocarcinoma. Their clinical data were analyzed retrospectively. Results All these patients underwent radical resection of hilar cholangiocarcinoma of type Bismuth-I successfully. The volume of blood loss was (179.50 ± 98.05) ml and duration of hospital stay was (11.80 ± 2.49) d of laparoscopic group which was lower than (261.25 ± 97.33) ml, (16.25 ± 3.35) d of open group (P < 0.05). The levels of Tbil of laparoscopic group at days after operation 1, 3, 5 d were (102.20 ± 45.49) mmol/L, (83.57 ± 30.66) mmol/L, (45.09 ± 18.41) mmol/L. The levels of Tbil of open group at days after operation 1, 3, 5 d were (148.17 ± 62.78) mmol/L, (121.60 ± 43.35) mmol/L, (80.59 ± 43.89) mmol/L. The difference was statistically significant (P < 0.05). And the laparoscopic group postoperative number of lymph nodes dissected (9.79 ± 3.05), postoperative complications (1 cases), positive margin (0 cases); and open group (9.30 ± 3.06), 3 cases, had no statistically significant differences were compared (P >0.05). Two groups of patients were followed up for 6~18 months. During the follow-up period, there was no recurrence or metastasis in the two groups. Conclusion Laparoscopic Bismuth-I radical resection of hilar bile duct carcinoma in lymph node dissection, postoperative complications, positive margin rate, prognosis and open type Bismuth-I hilar cholangiocarcinoma radical operation of similar effects, and more minimally invasive advantages. Therefore, laparoscopic radical resection for hilar cholangiocarcinoma of type Bismuth-I is safe and feasible.