| 摘要: |
| ［摘要］ 目的 探讨腹腔镜与开腹胆囊癌意向性根治切除术的疗效，为临床治疗选择提供循证依据。方法 回顾性分析2017年1月至2022年12月昆明医科大学第二附属医院收治的接受胆囊癌意向性根治切除术的150例患者的临床资料，根据手术方式分为腹腔镜手术组（48例）和开腹手术组（102例）。采用倾向性评分匹配平衡基线资料差异，匹配成功72例，其中腹腔镜手术组36例，开腹手术组36例。比较两组围手术期指标及生存预后的差异。通过Cox回归分析影响患者生存预后的危险因素。结果 匹配后两组基线资料均衡。腹腔镜手术组术中出血量显著少于开腹手术组（P<0.05），术后住院时间显著短于开腹手术组（P<0.05）。生存分析结果显示，对于T3期及以下的胆囊癌患者，两组总生存期无显著差异（P>0.05）。Cox回归分析结果显示，合并胆囊结石和T3分期是影响GBC患者生存预后的独立危险因素［HR（95%CI）=1.70（1.02～2.83），P=0.040；HR（95%CI）=6.07（1.44～25.60），P=0.014］。结论 腹腔镜胆囊癌根治术在严格筛选的T3期以下患者中与开腹手术疗效相当，但仍需更多高质量循证证据进一步验证。 |
| 关键词: 胆囊癌 腹腔镜 倾向性评分匹配 疗效 安全性 |
| DOI：10.3969/j.issn.1674-3806.2025.09.03 |
| 分类号:R 735.8 |
| 基金项目:国家自然科学基金项目（编号：82460461）；云南省科技厅科技计划项目（编号：202205AC160063，202401AW070003）；云南省教育厅科学研究基金项目（编号：2025J325） |
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| Comparison of efficacy between laparoscopic and laparotomic intention-to-cure radical resections for gallbladder cancer |
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ZHENG Kai, JIANG Gaiming, LI Jing, KANG Qiang, YANG Chen, KE Yang, LI Yuehua
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The Second Ward of Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
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| Abstract: |
| ［Abstract］ Objective To explore the efficacy between laparoscopic and laparotomic intention-to-cure radical resections for gallbladder cancer, and to provide evidence-based basis for clinical treatment options. Methods A retrospective analysis was conducted on the clinical data of 150 patients who were admitted to the Second Affiliated Hospital of Kunming Medical University and received intention-to-cure radical resection for gallbladder cancer from January 2017 to December 2022. According to the surgical methods, the patients were divided into laparoscopic surgery group(48 patients) and laparotomic surgery group(102 patients). Propensity score matching(PSM) was used to balance the differences in baseline data. A total of 72 patients were successfully matched, including 36 patients in the laparoscopic surgery group and 36 patients in the laparotomic surgery group. The differences in perioperative indicators and survival prognosis were compared between the two groups. The risk factors affecting the survival prognosis of the patients were analyzed by using Cox regression. Results After matching, the baseline data in the two groups were balanced. The laparoscopic surgery group had significantly less intraoperative blood loss and significantly shorter postoperative hospital stay than the laparotomic surgery group(P<0.05). The results of survival analysis showed that for the gallbladder cancer patients with stage T3 and below, there was no significant difference in overall survival between the laparoscopic surgery group and the laparotomic surgery group(P>0.05). The results of Cox regression analysis showed that complicating cholecystolithiasis and stage T3 were independent risk factors affecting the GBC patients′ survival prognosis［HR(95%CI)=1.70(1.02-2.83), P=0.040; HR(95%CI)=6.07(1.44-25.60), P=0.014］. Conclusion In radical cholecystectomy, for the patients with stage T3 and below who have been strictly screened, the efficacy of laparoscopic surgery is comparable to that of laparotomic surgery. However, the conclusion still requires more high-quality evidence-based practice for further verification. |
| Key words: Gallbladder cancer Laparoscope Propensity score matching(PSM) Efficacy Safety |
