完全腹腔镜胆囊癌根治术的临床疗效
Clinical effect of totally laparoscopic radical resection for gallbladder cancer
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摘要:
目的:探讨完全腹腔镜胆囊癌根治术的安全性及可行性。
方法:采用回顾性横断面描述性研究方法。收集2013年1月至2015年8月中山大学孙逸仙纪念医院收治的30例行完全腹腔镜胆囊癌根治术患者的临床资料。根据患者病情联合行肝段或肝外胆道切除术，行肝外胆道切除术者需行相应胆肠吻合术。根据术后病理学检查结果，选择行术后辅助化疗。观察指标：(1)手术情况：手术方式、手术时间、术中出血量、术中淋巴结清扫数目。(2)术后情况：术后下床活动时间、术后进食时间、术后拔除引流管时间、术后并发症发生情况、术后住院时间。(3)术后病理学检查结果：肿瘤分期、切缘情况。(4)术后辅助治疗情况。(5)随访情况：患者生存及肿瘤复发、转移情况。采用门诊和电话方式进行随访，随访时间截至2015年12月。随访患者生存及肿瘤复发、转移情况。计量资料以平均数(范围)表示。
结果:(1)30例患者均顺利完成完全腹腔镜胆囊癌根治术，均联合行肝S4b和S5段切除＋N1区域淋巴结清扫术。其中6例患者肿瘤侵犯肝外胆管致梗阻性黄疸联合行腹腔镜肝外胆道切除＋胆肠RouxenY吻合术。无围术期死亡患者。平均手术时间为238 min(178～430 min)，平均术中出血量为250 mL(200～600 mL)，平均术中淋巴结清扫数目为7枚(4～15枚)。(2)患者均于术后第2天下床活动并恢复饮食。平均术后拔除引流管时间为3 d(0～25 d)。术后2例患者发生并发症，均经对症处理后痊愈。平均术后住院时间为5 d (3～28 d)。(3)术后病理学检查：30例患者均为R0切除；病理学分期：ⅠB期12例，Ⅱ期10例，ⅢA期 7例，ⅢB期1例。(4)1例ⅢB期(pT3N1M0期)患者于术后行吉西他滨＋顺铂化疗， 其余患者术后未行辅助治疗。(5)30例患者术后均获得随访。随访时间为4～32个月，中位随访时间为16个月。随访期间，未见Trocar穿刺部位肿瘤复发、转移。25例患者无瘤生存，5例患者因肿瘤复发死亡。
结论:腹腔镜胆囊癌根治术安全可行，近期疗效较满意。Abstract:Objective:To investigate the safety and feasibility of totally laparoscopic radical resection of gallbladder cancer.
Methods:The retrospective crosssectional descriptive study was adopted. The clinical data of 30 patients who underwent laparoscopic radical resection of gallbladder cancer at the Sun Yatsen Memorial Hospital of Sun Yatsen University from January 2013 to August 2015 were collected. The patients received synchronous hepatic segmental or extrahepatic bile duct resection according to the conditions of patients, and choledochojejunostomy was applied to patients undergoing extrahepatic bile duct resection. The patients accepted postoperative adjuvant chemotherapy according to the results of postoperative pathological examination. Observation indicators included (1) operation situations, including surgical procedures, operation time, volume of intraoperative blood loss and number of lymph node dissected, (2) postoperative situations, including time for outoffbed activity, time for diet intake, time of drainage tube removal, occurrence of complications and duration of hospital stay, (3) results of postoperative pathological examination, including tumor stage and surgical margin, (4) postoperative adjuvant treatment, (5) followup situation including the survival of patients, tumor recurrence and metastasis. The followup using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015. Count data were represented as average (range).
Results:All the 30 patients underwent successful laparoscopic radical resection of gallbladder cancer combined with hepatic S4b and S5 resection+lymph node dissection at N1 region. Six patients with obstructive jaundice caused by tumor invaded to extrahepatic bile duct underwent combined laparoscopic extrahepatic bile duct resection+RouxenY hepaticojejunostomy, without perioperative death.The average operation time, average volume of intraoperative blood loss and average number of intraoperative lymph node dissected were 238 minutes (range, 178-430 minutes), 250 mL (range, 200-600 mL) and 7 (range, 4-15), respectively. (2) The patients got outoffbed activity and normal diet intake at postoperative day 2, with a average time of drainage tube removal of 3 days (range, 0-25 days) and an average duration of hospital stay of 5 days (range, 3-28 days). Two patients with complications were cured by symptomatic treatment. (3) Results of postoperative pathological examination showed that all the patients received R0 resection, and pathological stage showed that 12 patients were detected inⅠB stage, 10 inⅡstage, 7 in ⅢA stage and 1 in ⅢB stage. (4) One patient in ⅢB stage (pT3N1M0 stage ) received gemcitabine+cisplatin chemotherapy and other patients didn′t receive the adjuvant treatment. (5) All the patients were followed up for a median time of 16 months (range, 4-32 months), without tumor recurrence and metastasis at Trocar puncture site. There were 25 patients with tumorfree survival and 5 patiens died of tumor recurrence.
Conclusion:Laparoscopic radical resection of gallbladder cancer is technically safe and feasible, with a satisfactory shortterm outcome.-
Keywords:
- Radical resection /
- Laparoscopy
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