胆肠吻合术加T管引流术治疗胆囊癌的短期疗效及对中位生存时间及术后并发症的影响

doi:10.3969/j.issn.1006-6233.2023.03.013

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摘要 目的: 探讨胆囊切除加胆管T管引流术或胆肠吻合术(Choledochojejunostomy,CJ)治疗胆囊癌(Gall bladder Cancer,GC)的短期疗效及对中位生存时间及术后并发症的影响。方法: 回顾性分析2018年1月至2018年12月在我院肝胆外科进行腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)的121例患者的临床资料,选取其中121例,根据辅助治疗方式分为两组,对照组(n=61例,LC+胆管T管引流术),观察组(n=60例,LC+CJ),比较两组患者围术期指标、免疫应激反应、术后并发症、短期疗效与中位生存时间。结果: 观察组手术时间、术后肛门首次排气时间、术中出血量与对照组无区别(P<0.05),但住院时间短于对照组(P<0.05);观察组免疫球蛋白M(IgM)、免疫球蛋白G(IgG)与C反应蛋白(CRP)手术前后变化幅度均低于对照组(P<0.05);观察组术后14d并发症合计发生率低于对照组(P<0.05);观察组治疗总有效率与对照组比较差异无统计学意义(P>0.05);两组患者生存率比较差异无统计学意义(P>0.05)。结论: GC切除加CJ治疗GC较胆管T管引流术可减少患者术后住院天数,降低术后并发症与免疫应激反应,二者中位生存时间相当,可以在临床上进行推广。

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	赵黎
	李赟
	束翌俊
	王静

关键词 ：胆囊切除, 胆管T管引流, 胆肠吻合术

Abstract：Objective: To explore the short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy (CJ) in the treatment of gallbladder cancer (GC) and its effects on the median survival time and postoperative complications. Methods: The clinical data of 121 patients who underwent laparoscopic cholecystectomy (LC) in department of hepatobiliary surgery of the hospital from January 2018 to December 2018 were retrospectively analyzed. According to the adjuvant treatment methods, the patients were divided into two groups: including control group (n=61, LC+bile duct T-tube drainage) and observation group (n=60, LC+CJ). The perioperative indicators, immune stress response, postoperative complications, short-term efficacy, and median survival time were compared between the two groups of patients. Results: The surgical time, postoperative anal first exhaust time, and intraoperative blood loss in observation group were no different from those in control group (P<0.05), but the hospital stay was shorter than that in control group (P<0.05). The changes of immunoglobulin M (IgM), immunoglobulin G (IgG) and C-reactive protein (CRP) before and after surgery in observation group were lower than those in control group (P<0.05). The total incidence rate of complications in observation group at 14 days after surgery was lower than that in control group (P<0.05). There was no statistical significance in the effective rate of treatment between observation group and control group (P>0.05). There was no statistical difference between the two groups in terms of survival rate (P>0.05). Conclusion: Compared with bile duct T-tube drainage, GC+CJ in the treatment of GC can better shorten the postoperative hospital stay and reduce the postoperative complications and immune stress response, but and the median survival time of the two is similar, which can be promoted in clinical practice.

Key words： Cholecystectomy Bile duct T-tube drainage Choledochojejunostomy

基金资助:国家自然科学基金资助项目,(编号:82173081)

引用本文:

赵黎, 李赟, 束翌俊, 王静. 胆肠吻合术加T管引流术治疗胆囊癌的短期疗效及对中位生存时间及术后并发症的影响[J]. 河北医学, 2023, 29(3): 418-422.
ZHAO Li, LI Yun, SHU Yijun, et al. Short-Term Efficacy of Choledochojejunostomy plus T-tube Drainage in the Treatment of Gallbladder Cancer and Its Effects on Median Survival Time and Postoperative Complications. HeBei Med, 2023, 29(3): 418-422.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.03.013 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I3/418