摘要
目的探讨淋巴结清扫(lymph node dissection,LND)对术前影像学诊断淋巴结阴性的肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)病人预后的影响。方法回顾性收集2014年1月至2019年9月在中国医科大学附属盛京医院普通外科行根治性手术且术前影像学诊断淋巴结阴性的ICC病人临床资料。采用倾向性评分匹配(PSM)减少选择偏倚,比较淋巴结清扫组(LND组)与淋巴结未清扫组(NLND组)病人的术后短期及长期疗效。结果研究共纳入影像学诊断淋巴结阴性ICC病人92例,其中LND组43例,NLND组49例。PSM后每组各36例,两组手术时间[(347.2±258.3)min比(306.1±273.7)min]、术后并发症发生率[27.78%(10/36)比22.22%(8/36)]和术后住院时间[(12.05±9.48)d比(11.81±4.72)d],差异均无统计学意义(P>0.05);LND组术中出血量多于NLND组[(265.61±98.52)mL比(220.47±96.53)mL,t=2.421,P=0.049],术后拔管时间LND组也长于NLND组[(7.41±3.05)d比(7.29±2.91)d,t=3.697,P=0.013];LND组和NLND组中位无复发生存时间分别为13个月和9个月(χ^(2)=6.195,P=0.012),中位总生存时间分别为20个月和15个月(χ2=6.601,P=0.010)。LND组1、2年无复发生存率分别为54.6%、28.0%,NLND组分别为28.7%、9.6%(P<0.05);LND组1、2年总生存率分别为79.7%、37.2%,NLND组分别为60.4%、12.6%(P<0.05)。结论淋巴结清扫并不会明显增加术前影像学诊断淋巴结阴性的ICC病人的手术风险,但能使病人生存明显获益。
Objective To evaluate the effect of preoperative imaging examination upon lymph node dissection(LND)for intrahepatic cholangiocarcinoma(ICC)with negative lymph nodes.Methods Between January 2014 and September 2019,clinical data were retrospectively reviewed for 92 ICC patients diagnosed with negative lymph nodes by preoperative imaging undergoing radical operations.Propensity score matching(PSM)was utilized for minimizing selection bias.Short-term and long-term outcomes of patients with LND(n=43)and those without LND(NLND,n=49)were compared.Results After PSM,there were 36 cases in each group and no significant inter-group differences existed in mean operative duration[(347.2±258.3)vs.(306.1±273.7)min],postoperative complication rate[27.78%(10/36)vs.22.22%(8/36)]or average postoperative hospitalization time[(12.05±9.48)vs.(11.81±4.72)d](P>0.05).The average volume of intraoperative blood loss[(265.61±98.52)vs.(220.47±96.53)mL,t=2.421,P=0.049]and postoperative extubation time[(7.41±3.05)vs.(7.29±2.91)d,t=3.697,P=0.013]were higher in LND group than those in NLND group.The median relapse-free survival time was 13 months in LND group versus 9 months in NLND group(χ2=6.195,P=0.012)and the median overall survival time 20 and 15 months in NLND group(χ^(2)=6.601,P=0.010).The 1-,2-year relapsed-free survival rates were 54.6%,28.0%in LND group and 28.7%,9.6%in NLND group(P<0.05).And the 1-,2-year overall survival rates were 79.7%,37.2%in LND group and 60.4%,12.6%in NLND group(P<0.05).Conclusion Lymph node dissection does not significantly elevate the surgical risk of ICC patients with negative lymph nodes diagnosed by preoperative imaging.However,it offers significant survival benefits for ICC.
作者
张荷月
徐锋
金添强
王俊旗
范津铭
戴朝六
Zhang Heyue;Xu Feng;Jin Tianqiang;Wang Junqi;Fan Jinming;Dai Chaoliu(Department of General Surgery,Affiliated Shengjing Hospital,China Medical University,Liaoning Shenyang 110004,China)
出处
《腹部外科》
2022年第4期252-257,共6页
Journal of Abdominal Surgery
基金
辽宁省自然科学基金(20180551193,2020-MS-181)
盛京医院345人才工程计划(40B)。
关键词
胆管癌
肝切除
淋巴结清扫
预后
Cholangiocarcinoma
Hepatectomy
Lymph node excision
Prognosis
