| Objective:To explore the difference of short-term efficacy between laparoscopy and laparotomy in the treatment of peri-hilar cholangiocarcinoma,and preliminarily evaluates the safety and reliability of laparoscopy in the operation of perihilar cholangiocarcinoma.Methods:The medical records of patients with perihilar cholangiocarcinoma who received surgical treatment in Jiangxi Provincial People’s Hospital and the Second Affiliated Hospital of Nanchang University from December 2015 to December 2020 were collected.Including the patients age,gender and grade of preoperative liver function,liver function(ALT,AST,TBIL,propagated),operation time,intraoperative blood loss,number of lymph node cleaning,cutting edge positive rate,postoperative hospital stay,postoperative liver function changes and the incidence of postoperative complications(bile leakage,intraperitoneal hemorrhage,pulmonary infection,liver failure,abdominal cavity infection,infection of incision).According to the surgical methods,they were divided into laparoscopic group(n=24)and open group(n=28).The two groups of data were analyzed.The measurement data were compared by t-test of two independent samples,and the results were expressed as "x±s".The counting data were expressed by chi-square test or Fisher’s exact probability test,and P < 0.05 indicated statistically significant difference.Results:There were no significant differences in age,gender,preoperative liver function grade and preoperative liver function indexes between the two groups(P>0.05).In the laparoscopic group,there were 21 cases of hilar cholangiocarcinoma(10 cases of type I,7 cases of type II,3 cases of type III,and 1 case of type IV),2 cases of gallbladder carcinoma invading hilar,and 1 case of intrahepatic cholangiocarcinoma invading hilar.In the open group,there were 24 cases of hilar cholangiocarcinoma(8cases of type I,5 cases of type II,7 cases of type III,4 cases of type IV),2 cases of gallbladder carcinoma invading hilar and 2 cases of intrahepatic cholangiocarcinoma invading hilar.Compared with the relevant indexes of perioperative period,the operative time of the laparoscopic group was slightly longer than that of the open group(392.12±75.00 min vs 317.22±47.27min),while the intraoperative blood loss,postoperative ventilation time and postoperative hospital stay were significantly shorter in the laparoscopic group than that of the open group(245.29±133.23 ml vs444.45±277.81ml;3.29±1.35 d vs 4.11±1.21d;11.59±1.66 d vs 14.26±2.69d),the difference was statistically significant(P<0.05).There were no statistical significance in the number of lymph node dissection and positive rate of surgical margin between the two groups(P>0.05).Postoperative complications in the two groups included 2cases in the laparoscopic group and 3 cases in the open group.1 case in laparoscopic group and 2 cases in open group.1 case of postoperative pulmonary infection in laparoscopic group and 3 cases in open group;Postoperative liver failure: 1 case in laparoscopic group and 1 case in open group;No incision infection and abdominal cavity infection occurred in the laparoscopic group,while 3 cases and 2 cases of abdominal cavity infection occurred in the open group.There were no significant differences in postoperative complications such as bile leakage,abdominal hemorrhage,liver failure and abdominal infection between the two groups(P>0.05),but the incision infection rate of the laparoscopic group was significantly lower than that of the open group(P<0.05).There were no significant difference in liver function indicators(P> 0.05)in 1,3,7 days after the surgery of TBIL,ALT,AST,and ALB(P>0.05).Conclusion:Laparoscopic surgery can achieve the same short-term therapeutic effect as laparotomy in the treatment of peri-hilar cholangiocarcinoma,and better than laparotomy in intraoperative blood loss,postoperative intestinal function recovery,postoperative hospital stay,postoperative incision infection rate and other aspects. |
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