摘要
目的探讨肝内胆管癌(ICC)根治术不同淋巴结清扫方式对淋巴结检出数目及预后的影响。方法采用回顾性队列研究方法。收集2011年1月至2016年1月南昌大学第二附属医院收治的57例行ICC根治术患者的临床病理资料;男25例,女32例;平均年龄为59岁,年龄范围为45~72岁。57例患者中,36例术中采用整块融合淋巴结清扫方式,设为观察组;21例术中采用常规淋巴结清扫方式,设为对照组。观察指标:(1)术中情况。(2)术后病理学检查情况。(3)术后并发症情况。(4)随访情况。采用门诊或电话方式进行随访。所有患者出院后每6个月随访1次,了解患者生存情况。随访时间截至2019年1月。正态分布的计量资料以±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示,组间比较采用Mann-Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ2检验或Fisher确切概率法。等级资料组间比较采用Mann-Whitney U检验。采用Kaplan-Meier法绘制生存曲线并计算生存率,采用Log-rank检验进行生存分析。结果(1)术中情况:观察组患者手术时间,术中出血量,肝门阻断时间,肝段切除数(<3段、≥3段)分别为(218±53)min,(266±24)mL,(21±9)min,5、31例;对照组患者上述指标分别为(207±45)min,(270±23)mL,(19±8)min,2、19例,两组患者上述指标比较,差异均无统计学意义(t=-0.530,0.774,0.590,χ2=0.004,P>0.05)。(2)术后病理学检查情况:观察组患者术后淋巴结检出数目、阳性淋巴结百分比分别为(11±3)枚、16.58%(66/398),对照组患者上述指标分别为(5±2)枚、6.80%(7/103),两组患者上述指标比较,差异均有统计学意义(t=-9.454,2.148,P<0.05)。(3)术后并发症情况:观察组患者Clavien-Dindo分级Ⅰ~Ⅱ级、Ⅲ~Ⅴ级并发症,胆汁漏,术后出血,切口感染,胃瘫分别为35、1例,6例,1例,8例,0;对照组患者上述指标分别为19、2例,3例,1例,1例,2例,两组患者并发症Clavien-Dindo分级情况,胆汁漏,切口感染比较,差异均无统计学意义(χ2=0.236,0.000,1.870,P>0.05);两组患者术后出血、胃瘫比较,差异均无统计学意义(P>0.05)。(4)随访情况:57例患者均获得术后随访,随访时间为5~42个月,中位随访时间为36个月。观察组患者术后生存时间、术后3年总体生存率分别为36个月(8~42个月)、66.7%;对照组患者上述指标分别为23个月(5~39个月)、38.1%,两组患者上述指标比较,差异均有统计学意义(Z=-2.253,χ2=5.317,P<0.05)。结论ICC根治术采取整块融合淋巴结清扫有利于增加术后淋巴结检出数目,提高患者术后生存率。
Objective To investigate the effects of different lymph node dissection methods in radical resection of intrahepatic cholangiocarcinoma(ICC)on the number of harvested lymph nodes and prognosis of patients.Methods The retrospective cohort study was conducted.The clinicopathological data of 57 patients with ICC who underwent radical resection in the Second Affiliated Hospital of Nanchang University from January 2011 to January 2016 were collected.There were 25 males and 32 females,aged from 45 to 72 years,with an average age of 59 years.Of the 57 patients,36 undergoing en bloc fusion lymph node dissection and 21 undergoing conventional lymph node dissection were allocated into observation group and control group,respectively.Observation indicators:(1)intraoperative situations;(2)results of postoperative pathological examination;(3)postoperative complications;(4)follow-up.Follow-up using outpatient examination or telephone interview was performed once every six months after hospital discharge to detect survival of patients up to January 2019.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was done using the t test.Measurement data with skewed distribution were described as M(range),and comparison between groups was analyzed by the Mann-Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact propability.Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test.The survival curve and rate were drawn and calculated using the Kaplan-Meier method,and survival of patients was analyzed by the Log-rank test.Results(1)Intraoperative situations:operation time,volume of intraoperative blood loss,hepatic portal occlusion time,cases with<3 segments of hepatectomy and≥3 segments of hepatectomy for the observation group were(218±53)minutes,(266±24)mL,(21±9)minutes,5,31,respectively,versus(207±45)minutes,(270±23)mL,(19±8)minutes,2,19 for the control group,showing no significant difference in the above indicators between the two groups(t=-0.530,0.774,0.590,χ2=0.004,P>0.05).(2)Results of postoperative pathological examination:the number of harvested lymph nodes and percentage of positive lymph nodes of the observation group were 11±3 and 16.58%(66/398),respectively,versus 5±2 and 6.80%(7/103)of the control group,showing significant differences in the above indicators between the two groups(t=-9.454,2.148,P<0.05).(3)Postoperative complications:cases with Clavien-Dindo gradeⅠ-Ⅱcomplications or Clavien-Dindo gradeⅢ-Ⅳcomplications,cases with bile leakage,cases with postoperative hemorrhage,cases with incision infection,cases with gastroparesis were respectively 35,1,6,1,8,0 in the observation group and 19,2,3,1,1,2 in the control group.There was no significant difference in the cases with complications of Clavien-Dindo classification,cases with bile leakage,cases with incision infection between the two groups(χ2=0.236,0.000,1.870,P>0.05)and no significant difference in the cases with postoperative hemorrhage,cases with gastroparesis between the two groups(P>0.05).(4)Follow-up:57 patients were followed up for 5-42 months,with a median time of 36 months.The survival time and postoperative 3-year survival rate were respectively 36 months(range,8-42 months)and 66.7%of the observation group,versus 23 months(range,5-39 months)and 38.1%of the control group,showing significant differences in the above indicators between the two groups(Z=-2.253,χ2=5.317,P<0.05).Conclusion For radical resection of ICC,the en bloc fusion lymph node dissection is beneficial to increase the number of harvested lymph nodes and improve survival rate of patients.
作者
张军
梁博
付晓伟
杜鹏程
曾仁贵
乐豪
方路
Zhang Jun;Liang Bo;Fu Xiaowei;Du Pengcheng;Zeng Rengui;Le Hao;Fang Lu(Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2020年第2期191-195,共5页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(81760483)
江西省重点研发计划(20171BBG70063)。
关键词
肝肿瘤
肝内胆管癌
淋巴结清扫
淋巴结检出数目
术后
生存率
Hepatic neoplasms
Intrahepatic cholangiocarcinoma
Lymph node dissection
The number of harvested lymph nodes
Postoperative
Survival rate
