摘要
目的研究肝内胆管细胞癌(ICC)根治性切除术中行不同淋巴结范围清扫的效果及对患者预后的影响。方法回顾性选取2018年1月至2021年12月接受根治性肝切除术+区域淋巴结清扫(LND)治疗的85例ICC患者资料,根据术中淋巴结清扫范围不同分为常规组(n=33)和扩大组(n=52),常规清扫基础上依据原发灶起源部位行左右半肝扩大淋巴结清扫)。采用SPSS 20.0进行数据分析,计量资料用(x±s)表示,采用独立样本t检验;并发症等计数资料比较采用好或Fisher检验。生存情况采用Kaplan-Meier曲线进行分析,行Log-Rank检验。P<0.05为差异有统计学意义。结果两组患者均顺利完成手术,无围手术期死亡病例。扩大组手术时间、术中出血、淋巴结清扫、术后排气时间、胃肠功能恢复时间、术后住院时间与常规组比较均无统计学意义(P>0.05)。扩大组患者术后并发症发生率、复发率及1年、3年、5年患者累积总生存率比较,差异亦未见统计学意义(P>0.05)。结论对可行手术切除的ICC患者,无论是行常规肝十二指肠韧带和肝总动脉旁淋巴结清扫,还是术中根据病灶起源部位联合行左半肝胃小弯、胃贲门附近及右半肝门静脉、胰头后淋巴结扩大清扫,均不影响患者预后生存。建议ICC根治性切除术中根据患者基础疾病及淋巴结实际状态等,合理选择LND范围及制定个性化清扫方案,避免盲目扩大清扫。
Objective To investigate the effeet of different lymph node dissection in radical resection of intrahepatic cholangiocarcinoma(ICC)and its influence on the prognosis of patients.Methods Data of 85 ICC patients who received radical hepatectomy plus regional lymph node dissection(LND)from January 2018 to December 2021 were retrospectively selected,and divided into conventional group(n=33)and expanded group(n=52)according to the scope of intraoperative lymph node dissection.On the basis of routine dissection,left and right half liver enlarged lymph node dissection was performed according to the origin of the primary lesion).SPSS 20.0 was used for data analysis.Measurement data were represented by(x±s)and independent t test was used.The statistical data of complications were compared by χ^(2) or Fisher test.Survival was analyzed by Kaplan-Meier curve and tested by Log-Rank.P<0.05 was considered statistically significant.Results Both groups of patients successully completed the operation,no perioperative death cases.There were no significant differences in operation time,intraoperative bleeding,lymph node dissection,postoperative exhaust time,gastrointestinal function recovery time and postoperative hospitalization time in the extended group compared with the conventional group(P>0.05).There was no significant difference in.postoperative complication rale,recurrence rate and 1,3 and 5-year cumulative overall survival rate in the expanded group(P>0.05).Conclusions For ICC patients who could be surgically resectable,no matter routine hepatoduodenal ligamenta and para-hepatic common artery lymph node dissection,or intraoperative combined with enlarged lymph nodes in the left half of hepatogastric flexus,near the gastric cardia,right half of hepatic portal vein,and head of pancreas according to the origin of the lesion,the prognosis of the patients was not afected.It is suggested that the scope of LND should be reasonably selected and personalized cleaning plan should be developed according to the underlying disease and actual status of lymph nodes in ICC radical resection,so as to avoid blindly expanding cleaning.
作者
黄小龙
林师佈
韩霖
陈有科
杨彦
Huang Xiaolong;Lin Shibu;Han Lin;Chen Youke;Yang Yan(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Hainan Medical College,Haikou Hainan Province 570102,China)
出处
《中华普外科手术学杂志（电子版）》
2023年第4期401-404,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
国家自然科学基金(81860514)。
关键词
肝内胆管细胞癌
肝切除术
淋巴结切除术
预后
Intrahepatic Cholangiocareinoma
Hepatectomy
Lymph Node Excision
Prognosis
