Comparison of the efficacy and safety of two hepatectomy methods in the treatment of type Ⅲ/Ⅳ hilar cholangiocarcinoma

doi:10.3877/cma.j.issn.1674-3946.2021.06.028

Abstract

Abstract:

Objective

To investigate and compare the efficacy and safety of extended hepatectomy and limited hepatectomy in the treatment of type Ⅲ/Ⅳ hilar cholangiocarcinoma (HCCA).

Methods

Data of 86 patients with type Ⅲ/Ⅳ HCCA from January 2012 to October 2015 were retrospectively analyzed. 40 patients were treated with traditional limited hepatectomy (limited group) and 46 patients were treated with extended hepatectomy (extended group). The patients were followed up for 5 years. SPSS 21.0 statistical analysis software was used for comparison. Independent sample t test was used for the measurement data of perioperative indicators of the two groups. Chi square test was used for the incidence of postoperative complications and 1-, 3 -, 5-year survival rate. Log rank test was used for the survival analysis of patients. P<0.05 was considered statistically significant.

Results

The operation time, intraoperative blood loss, postoperative pain score, postoperative pain injection times, exhaust time, intestinal function recovery time and hospitalization time of the extended group were greater than those of the limited group (P<0.05), but the 3-year and 5-year survival rates were higher than those of the limited group (P<0.05), and the recurrence rate was lower than that of the limited group (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05).

Conclusion

Extended hepatectomy for type Ⅲ/Ⅳ HCCA a reliable treatment that can significantly prolong the survival time and reduce the postoperative recurrence rate, without increasing the incidence of complications due to surgical trauma.

Key words: Bile duct neoplasms, Hepatectomy, Comparative effectiveness research, Safety

Jianlong Ding, Xiaochen Liu, Jianfeng Duan, Fan Yang, Changhu Duan, Heng Huang, Linxun Liu. Comparison of the efficacy and safety of two hepatectomy methods in the treatment of type Ⅲ/Ⅳ hilar cholangiocarcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(06): 686-689.

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Figures/Tables 5

References 20

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组别	例	年龄(岁)	男/女	BMI(kg/m²)
扩大组	46	56.3±9.5	28/18	27.8±5.6
局限组	40	56.8±9.7	23/17	27.1±5.5
t/χ²/F值		0.295	0.101	0.672
P值		0.317	0.368	0.328
组别	例	TBIL(μmol/L)	Bismuth-Corlette分期
组别	例	TBIL(μmol/L)	Ⅲa/Ⅲb/IV
扩大组	46	302.8±36.9	15/16/15
局限组	40	301.5±35.7	13/13/14
t/χ²/F值		0.298	0.387
P值		0.232	0.388

组别	例	年龄(岁)	男/女	BMI(kg/m²)
扩大组	46	56.3±9.5	28/18	27.8±5.6
局限组	40	56.8±9.7	23/17	27.1±5.5
t/χ²/F值		0.295	0.101	0.672
P值		0.317	0.368	0.328
组别	例	TBIL(μmol/L)	Bismuth-Corlette分期
组别	例	TBIL(μmol/L)	Ⅲa/Ⅲb/IV
扩大组	46	302.8±36.9	15/16/15
局限组	40	301.5±35.7	13/13/14
t/χ²/F值		0.298	0.387
P值		0.232	0.388

组别	例	手术时间(min)	术中出血量(ml)	疼痛评分(分)
扩大组	46	408.9±56.2	1038.5±75.9	5.2±0.9
局限组	40	312.7±38.6	728.9±86.3	4.4±0.6
t值		39.623	32.518	11.281
P值		0.003	0.011	0.007
组别	例	镇痛药使用次数(次)	排气时间(d)	肠道功能恢复时间(d)	住院时间(d)
扩大组	46	1.9±0.6	2.8±0.9	3.2±0.8	15.6±2.8
局限组	40	0.8±0.7	2.0±0.8	2.3±0.6	12.3±2.2
t值		9.212	11.263	8.162	11.288
P值		0.036	0.016	0.022	0.006

组别	例	手术时间(min)	术中出血量(ml)	疼痛评分(分)
扩大组	46	408.9±56.2	1038.5±75.9	5.2±0.9
局限组	40	312.7±38.6	728.9±86.3	4.4±0.6
t值		39.623	32.518	11.281
P值		0.003	0.011	0.007
组别	例	镇痛药使用次数(次)	排气时间(d)	肠道功能恢复时间(d)	住院时间(d)
扩大组	46	1.9±0.6	2.8±0.9	3.2±0.8	15.6±2.8
局限组	40	0.8±0.7	2.0±0.8	2.3±0.6	12.3±2.2
t值		9.212	11.263	8.162	11.288
P值		0.036	0.016	0.022	0.006

组别	术后时间	扩大组(n＝46)	局限组(n＝40)	χ²值	P值
复发率	1年	8(17.4)^a	9(22.5)^a	0.352	0.382
	3年	18(39.1)^b	26(65.0)^b	5.731	0.041
	5年	28(60.9)^c	34(85.0)^c	6.191	0.033
生存率	1年	40(87.0)^d	32(80.0)^d	0.759	0.618
	3年	33(71.7)^e	18(45.0)^e	6.338	0.031
	5年	20(43.5)^f	8(20.0)^f	5.371	0.043

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