Comparative study of two different thrombectomy methods in hepatocellular carcinoma with cholangiocarcinoma thrombectomy

doi:10.3877/cma.j.issn.1674-3946.2023.01.011

Abstract

Abstract:

Objective

To compare the clinical effects of two different thrombectomy methods in laparoscopic hepatectomy for hepatocellular carcinoma（HCC）with bile duct carcinoma thrombus（BDTT）.

Methods

Clinical data of 41 patients with HCC accompanied by BDTT from January 2017 to December 2020 were retrospectively analyzed. All patients underwent laparoscopic hepatectomy and were divided into two groups according to different methods of intraoperative thrombectomy：21 patients in the observation group underwent cholangiectomy and 20 patients in the control group underwent extrahepatic cholangiectomy. SPSS 22.0 software was used to complete the data analysis，and the enumerations of postoperative complications were performed by χ² test or Fisher exact test. Measurement data such as perioperative indexes were expressed by（

x ˉ

±s），and t test was performed for comparison between groups. Kaplan-Meier survival curve was used to analyze cumulative overall survival（OS）and disease-free survival（DFS）. P<0.05 was considered statistically significant.

Results

Operative time，intraoperative blood loss，drainage tube removal time and postoperative hospital stay in observation group were all better than those in control group（P<0.05）. The incidence of postoperative long-term complications in observation group was significantly lower than that in control group（P<0.05）. Postoperative cumulative DFS and OS between the two groups showed no significant difference（Log-Rank χ²=0.092，P=0.761；χ²=0.030，P=0.863）.

Conclusion

Laparoscopic choledochotomy and extrahepatic choledochotomy in the treatment of HCC with BDTT have similar surgical safety and prognosis，but choledochotomy and choledochotomy have advantages of short operation time，less bleeding，earlier removal of drainage tube and low incidence of long-term complications，which are more conducive to postoperative recovery of patients.

Key words: Carcinoma，Hepatocellular, Bile Duct Carcinoma Thrombus, Bile Duct Incision for Thrombectomy, Comparative Effectiveness Research

Xingfei Yang, Peng Zhang, Lanjun Li, Guanghui Ma, Peiliang Hu, Tonghai Du, Zhenqing Sun. Comparative study of two different thrombectomy methods in hepatocellular carcinoma with cholangiocarcinoma thrombectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(01): 36-39.

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Figures/Tables 4

References 15

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组别	例	性别	年龄 (岁)	BMI (kg/m²)	肿瘤直径 (cm)
组别	例	男/女	年龄 (岁)	BMI (kg/m²)	肿瘤直径 (cm)
观察组	21	15/6	56.6±6.3	21.3±3.6	5.1±0.5
对照组	20	14/6	56.1±6.9	22.1±3.9	5.3±0.4
χ²/t值		0.010	0.243	0.683	1.410
P值		0.920	0.810	0.499	0.167
组别	例	肿瘤部位	癌栓位置	肝功能分级	Satoh分型
组别	例	左叶/右叶	D/E/F	A/B	Ⅱ/Ⅲ
观察组	21	7/14	13/6/2	14/7	19/2
对照组	20	6/14	11/6/3	12/8	17/3
χ²/t值		0.053	0.342	0.196	0.003
P值		0.819	0.843	0.658	0.954

组别	例	性别	年龄 (岁)	BMI (kg/m²)	肿瘤直径 (cm)
组别	例	男/女	年龄 (岁)	BMI (kg/m²)	肿瘤直径 (cm)
观察组	21	15/6	56.6±6.3	21.3±3.6	5.1±0.5
对照组	20	14/6	56.1±6.9	22.1±3.9	5.3±0.4
χ²/t值		0.010	0.243	0.683	1.410
P值		0.920	0.810	0.499	0.167
组别	例	肿瘤部位	癌栓位置	肝功能分级	Satoh分型
组别	例	左叶/右叶	D/E/F	A/B	Ⅱ/Ⅲ
观察组	21	7/14	13/6/2	14/7	19/2
对照组	20	6/14	11/6/3	12/8	17/3
χ²/t值		0.053	0.342	0.196	0.003
P值		0.819	0.843	0.658	0.954

组别	例	手术时间(min)	术中出血量(ml)		进食时间(d)
观察组	21	241.7±16.9	163.6±16.2		3.1±0.9
对照组	20	297.4±21.6	236.7±18.9		3.3±1.1
t值		9.221	13.318		0.639
P值		0.000	0.000		0.527
组别	例	引流管拔除时间(d)		术后住院时间(d)
观察组	21	5.1±1.2		10.3±3.2
对照组	20	6.2±0.9		13.7±3.8
t值		3.307		3.105
P值		0.002		0.004

组别	例	手术时间(min)	术中出血量(ml)		进食时间(d)
观察组	21	241.7±16.9	163.6±16.2		3.1±0.9
对照组	20	297.4±21.6	236.7±18.9		3.3±1.1
t值		9.221	13.318		0.639
P值		0.000	0.000		0.527
组别	例	引流管拔除时间(d)		术后住院时间(d)
观察组	21	5.1±1.2		10.3±3.2
对照组	20	6.2±0.9		13.7±3.8
t值		3.307		3.105
P值		0.002		0.004

组别	例	感染	出血		胆瘘	膈下积液
观察组	21	1	1		0	1
对照组	20	2	1		1	0
χ²/F值		0.702
P值		0.402
组别	例	肝功能衰竭		远期并发症			Clavien分级
组别	例	肝功能衰竭		a/b/c			Ⅰ-Ⅱ/Ⅲ-Ⅳ
观察组	21	0		1/0/0			4/0
对照组	20	2		3/2/2			7/6
χ²/F值				4.194			-
P值				0.041			0.237

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