目的

对比研究两种术式治疗肝内胆管细胞癌的临床效果。

方法

回顾性分析2018年12月至2023年12月90例肝内胆管细胞癌患者资料。按照术式不同分为两组。采用腹腔镜肝切除50例，设为腔镜组；采用开腹肝切除40例，设为开腹组。SPSS 22.0统计分析数据。围手术期指标等计量资料用（± s）表示，行独立样本t检验，术后并发症等计数资料用［例（%）］表示，采用χ²检验；应用Kaplan-Meier法计算生存率。P＜0.05表示差异具有统计学意义。

结果

90例肝内胆管细胞癌患者顺利完成肝切除术，无围手术期死亡。腔镜组患者在手术时间、术中出血量、手术切口、首次排气时间、下床活动时间、住院时间均优于开腹组，差异均有统计学意义（P＜0.05）。总并发症发生率低于开腹组（6% vs. 15%）,差异无统计学意义（P＞0.05）。平均随访时间30.2个月（2～62个月）中位无病生存时间（51.1 vs. 41.5）个月。腔镜组患者复发33例，死亡28例；开腹组患者复发28例，死亡人数23例。腔镜组患者5年累积总生存率与累积无病生存率（44.0%、34.0%）高于开腹组患者（42.5%、30%），差异无统计学意义（P＞0.05）。

结论

采用腹腔镜肝切除治疗肝内胆管细胞癌安全有效，可缩短手术时间，减少术中出血加快患者术后恢复，缩短术后住院时间。腹腔镜肝切除术和开腹肝切除术治疗肝内胆管细胞癌的远期疗效相当。

Objective

To compare the clinical effect of two kinds of operation on intrahepatic cholangiocarcinoma.

Methods

The data of 90 patients with intrahepatic cholangiocarcinoma from December 2018 to December 2023 were retrospectively analyzed.They were divided into two groups according to different operation methods.Laparoscopic hepatectomy was performed in 50 cases and the group was set as endoscopic group.40 patients underwent open liver resection and were set as the open group.SPSS 22.0 statistical analysis data.Perioperative indicators and other measurement data were represented by (x±s), independent sample t test was performed, postoperative complications and other statistical data were represented by［ cases (%)］,χ² test was used.Kaplan-Meier method was used to calculate the survival rate.P＜0.05 indicated that the difference was statistically significant.

Results

90 patients with intrahepatic cholangiocarcinoma successfully completed hepatectomy without perioperative death.The operative time, intraoperative blood loss, surgical incision, first exhaust time, time to get out of bed and time to stay in the endoscopic group were all better than those in the laparotomy group, with statistical significance (P＜0.05).The total complication rate was lower than that in the open group (6% vs. 15%), and the difference was not statistically significant (P＞0.05).The mean follow-up time was 30.2 months (2～62 months) and the median disease-free survival time (51.1 vs.41.5 months).In the endoscopic group, 33 patients relapsed and 28 died.In the laparotomy group, 28 patients relapsed and 23 died.The 5-year cumulative overall survival rate and disease-free survival rate (44.0% and 34.0%) in the endoscopic group were higher than those in the open group (42.5% and 30%), and the difference was not statistically significant (P＞0.05).

Conclusion

Laparoscopic hepatectomy is safe and effective in the treatment of intrahepatic cholangiocarcinoma, which can shorten operation time, reduce intraoperative bleeding,accelerate postoperative recovery and shorten postoperative hospital stay.The long-term efficacy of laparoscopic hepatectomy is comparable to that of open hepatectomy for intrahepatic cholangiocarcinoma.