作者：钟其焕，陈博艺，邓国荣，余勇，李荣，李称才

单位：广东省湛江中心人民医院 肝胆外科，广东 湛江 524045

Authors:  ZHONG Qihuan, CHEN Boyi, DENG Guorong, YU Yong, LI Rong, LI Shengcai

Unit:  Department of hepatobiliary surgery, Central People’s Hospital of Zhanjiang, Zhanjiang 524045, Guangdong, China

摘要：

目的  探讨腹腔镜胆管癌根治性切除术治疗Bismuth-CorletteⅠ、Ⅱ型肝门胆管癌(HC)的价值。方法  根据患者的意愿和病情等将56例Bismuth-CorletteⅠ、Ⅱ型HC患者分观察组(22例)和对照组(34例)。观察组采用腹腔镜胆管癌根治性切除术。对照组采用开腹胆管癌根治性切除术。对比两组患者的临床评价指标、肝功能指标、细胞免疫指标、应激指标和术后并发症。结果  与对照组相比,观察组的术中出血量明显少,术后首次下床活动和肛门排气明显早,术后住院时间和镇痛时间明显短,但手术时间明显长(P<0.05)。与对照组相比,观察组术后7 d的总胆红素浓度、丙氨酸氨基转移酶浓度和天门冬氨酸氨基转移酶浓度均明显低,但白蛋白的浓度明显高(P<0.05)。观察组术后3 d的血浆皮质醇、空腹血糖和C反应蛋白浓度均明显低于对照组(P<0.05)。观察组术后3 d的CD3+百分比、CD4+百分比和CD4+/CD8+值均明显高于对照组(P<0.05)。结论  腹腔镜胆道癌根治性切除术可明显减轻Bismuth-CorletteⅠ、Ⅱ型HC患者的手术创伤、应激反应和细胞免疫损伤,同时可加快术后康复和肝功能恢复。

关键词：  肝门胆管癌; 腹腔镜; 根治性切除术; Bismuth-Corlette Ⅰ型; Bismuth-Corlette Ⅱ型

Abstract：

Objective  To investigate the value of laparoscopic radical resection of cholangiocarcinoma for Bismuth-Corlette type I and II hilar cholangiocarcinoma (HC). Methods  A total of 56 patients with Bismuth-Corlette type I and II HC were divided into observation group (22 cases) and control group (34 cases) according to patients' wishes and condition. The observation group was treated with laparoscopic radical resection of cholangiocarcinoma. The control group was treated with open radical resection of cholangiocarcinoma. The clinical evaluation index, liver function index, cellular immunity index, stress index and postoperative complications were compared between the two groups. Results  Compared with the control group, the bleeding volume of the observation group was significantly less, the first time out of bed and anal exhaust of the observation group were significantly earlier, the hospital stay and analgesia time of the observation group were significantly shorter, but the operation time of the observation group was significantly longer (P<0.05). Compared with the control group, the total bilirubin concentration, alanine aminotransferase concentration and glutamic oxalate aminotransferase concentration of 7 days after operation in the observation group were significantly lower, but the albumin concentration of 7 days after operation in the observation group was significantly higher (P<0.05). The concentration of plasma cortisol, fasting blood sugar and C-reactive protein of the 3 days after operation in the observation group was significantly lower than those in the control group (P<0.05). The percentages of CD3+, CD4+ and CD4+/CD8+ of 3 days after operation in the observation group were significantly higher than those in the control group (P<0.05). Conclusions  Laparoscopic radical resection of cholangiocarcinoma can significantly reduce the surgical trauma, stress response and cellular immune injury in patients with Bismuth-Corlette type I and II HC, and accelerate the recovery of liver function and postoperative recovery.

Key Words:  Hilar cholangiocarcinoma; Laparoscopy; Radical resection; Bismuth-Corlette type I; Bismuth-Corlette type II