腹腔镜与开放入路在胆囊癌治疗中的对比——Fundeni临床研究所9年的经验。

IF 0.8 Q4 SURGERY
Chirurgia Pub Date : 2025-04-01 DOI:10.21614/chirurgia.3111
Elena-Mihaela Vrabie, Iulian Mosteanu, Mihai-Adrian Eftimie, Irina Balescu, Alexandra Trotea, Gheorghe Potlog, Catalin-Andrei Savin, Luiza-Maria Tirca, Ali Alloub, Cezar Stroescu, Traian Dumitrascu, Irinel Popescu, Vladislav Brasoveanu, Nicolae Bacalbasa
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引用次数: 0

摘要

胆囊癌是最常见的胆道恶性肿瘤,常在胆囊切除术标本中偶然诊断为良性疾病。一旦组织病理学上确诊,治疗必须通过切除胆囊、肝床和局部淋巴结来完成。腹腔镜方法似乎是有效的和肿瘤安全的。我们研究的目的是通过文献综述和腹腔镜入路治疗胆囊癌的最新进展,介绍我们外科诊所9年来通过开放和腹腔镜入路治疗胆囊癌的经验。材料与方法:57例患者行根治性手术,26例患者行姑息性切除。在根治性手术中,52例采用开放入路,5例采用腹腔镜入路。57例中有14例是在单纯胆囊切除术标本上发现恶性组织病理学结果后完成手术的。在大多数病例中,原发性单纯性胆囊切除术采用腹腔镜入路。腹腔镜下再切除3例,术前切除2例。结果:开放组患者年龄中位数为64.21岁,腹腔镜组患者年龄中位数为67.2岁。大多数患者为女性。57名患者中有52名患者有一种或多种合并症,ASA评分为3或4分。腹腔镜组ASA评分较低。腹腔镜组的平均手术时间为308分钟,与开放组的294分钟相似。开放组并发症发生率较高。两组间淋巴结数量相近。腹腔镜组术后疼痛更小,恢复更快,住院时间更短(6.2天对13天)。胆囊癌早期无症状,晚期诊断限制了治疗选择。尽管如此,在胆囊切除术标本中偶然诊断为推定为良性疾病(T1-T3期)的病例中,可能会通过腹腔镜方法进行再次切除。此外,在预先诊断的选定病例中,腹腔镜切除可能由实验小组进行。结论:腹腔镜入路是治疗早期胆囊癌的理想选择。这种手术方法具有肿瘤安全性,相似的R0切除率和淋巴结数量。这种手术方法的最大效益是在有实验团队的大容量中心实现的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Laparoscopic versus Open Approach in Gallbladder Cancer Treatment - 9-Year Experience in Fundeni Clinical Institute.

Introduction: Gallbladder cancer is the most common biliary malignancy frequently diagnosed incidentally on cholecystectomy specimens for presumed benign disease. Once the diagnosis is confirmed on histopathologically, the treatment must be completed by resecting the gallbladder liver bed and regional lymph nodes. The laparoscopic approach seems to be efficient and oncologically safe. The aim of our study was to present the 9-year experience in treating gallbladder cancer in our surgery clinic by both open and laparoscopic approach completed by a literature review with the latest updates regarding the state of the laparoscopic approach in treating this type of cancer. Materials and Methods: Fifty-seven patients underwent radical surgery and 26 resections had a palliative purpose. Among radical resections, 52 were performed by using the open approach and 5 by using the laparoscopic approach. 14 cases out of 57 were completion procedures performed after a malignant histopathological finding was confirmed on a simple cholecystectomy specimen. In the majority of cases, the primary simple cholecystectomy was performed by laparoscopic approach. The laparoscopic approach was used in 3 cases of re-resection and 2 per-primam resections. Results: The median age of the patients was 64.21 years in the open group and 67.2 years in the laparoscopic group. Most patients were females. All patients had one or more comorbidities with an ASA score of 3 or 4 in 52 patients out of 57. ASA score had lower values in the laparoscopic group. The average surgery time for the laparoscopic group was 308 minutes, similar to the one for the open group that was 294 minutes. The complication rate was higher in the open group. The number of harvested lymph nodes was similar between the groups. The laparoscopic group benefited of lower postoperative pain, faster recovery and shorter hospital stay (6.2 days versus 13 days). Gallbladder cancer evolves asymptomatic in early stages and the diagnosis in advanced stages limits the therapeutic options. Still, in cases incidentally diagnosed on cholecystectomy specimens for presumed benign disease (stages T1-T3), the re-resection might be performed by laparoscopic approach. Also, in per-primam diagnosed selected cases, the laparoscopic resection might be performed by experimented teams. Conclusions: The laparoscopic approach is an ideal alternative to the open approach in treating early-stage gallbladder cancer. This surgical approach provides oncological safety, similar R0 resection rates and number of harvested lymph-nodes. The maximum benefit of this surgical approach is achieved in high-volume centers with experimented teams.

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来源期刊
Chirurgia
Chirurgia Medicine-Surgery
CiteScore
1.00
自引率
0.00%
发文量
75
审稿时长
4-8 weeks
期刊介绍: Chirurgia is a bimonthly journal. In Chirurgia, original papers in the area of general surgery which neither appeared, nor were sent for publication in other periodicals, can be published. You can send original articles, new surgical techniques, or comprehensive general reports on surgical topics, clinical case presentations and, depending on publication space, - reviews of some articles of general interest to surgeons from other publications. Chirurgia is also a place for sharing information about the activity of various branches of the Romanian Society of Surgery, information on Congresses and Symposiums organized by the Romanian Society of Surgery and participation notes in other scientific meetings. Letters to the editor: Letters commenting on papers published in Chirurgia are welcomed. They should contain substantive ideas and commentaries supported by appropriate data, and should not exceed 2 pages. Please submit these letters to the editor through our online system.
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