腹腔镜及开腹胆囊癌根治术对早期胆囊癌患者术后应激反应的影响比较OA
Laparoscopic versus open radical cholecystectomy for early-stage gallbladder cancer:A comparative analysis of postoperative stress response
目的 对比研究腹腔镜及开腹胆囊癌根治术对早期胆囊癌患者术后应激反应的影响,评估腹腔镜术式的安全性.方法 回顾性收集2017年1月至2024年5月在宁波市鄞州区第二医院治疗的早期胆囊癌患者82例,按照治疗方式不同分为腹腔镜组(n=38)和开腹组(n=44),观察两组围手术期指标和应激反应相关生化指标.结果 两组患者在性别、年龄、术前合并症及身体质量指数(BMI)方面差异无统计学意义(P>0.05);腹腔镜组在手术时间、术中出血量及术后住院时间方面少于开腹组,差异有统计学意义(P<0.05);两组在淋巴结清扫数目、术后并发症、肝脏切除范围、T分期及N分期方面差异无统计学意义(P>0.05);术前1 d,两组患者的C反应蛋白(CRP)、丙二醛(MDA)、超氧化物歧化酶(SOD)、血白细胞(WBC)、谷氨酸氨基转移酶(ALT)及天冬氨酸氨基转移酶(AST)水平比较,差异均无统计学意义(P>0.05).术后1 d、3 d,腹腔镜组的CRP、MDA、WBC、ALT及AST水平均低于开腹组,SOD水平高于开腹组,差异均有统计学意义(P<0.05).结论 腹腔镜胆囊癌根治术可以取得与开腹手术类似的淋巴结清扫效果,且具有术中出血少、术后恢复快等优势,对机体的应激反应小于开腹术式,所以在成熟的肝胆外科中心,腹腔镜胆囊癌根治术治疗早期胆囊癌是安全可行的.
Objective To compare the effects of laparoscopic versus open radical cholecystectomy on the postoperative stress response in patients with early-stage gallbladder cancer,and to assess the safety profile of the laparoscopic approach.Methods A total of 82 patients with early-stage gallbladder cancer who underwent surgical treatment in Ningbo Yinzhou No.2 Hospital were retrospectively enrolled between January 2017 and May 2024.They were allocated to either the laparoscopic group(n=38)or the open group(n=44)based on the surgical technique employed.Perioperative clinical outcomes and biological markers of stress response were compared between the two groups.Results Baseline characteristics including gender distribution,age,preoperative comorbidities,and body mass index(BMI),showed no significant differences between the two groups(P>0.05).The laparoscopic group exhibited significantly shorter operative time,less intraoperative blood loss,and a reduced postoperative hospital stay compared with the open group(P<0.05).No statistically significant differences were observed between the groups in terms of lymph node dissection yield,postoperative complication rates,extent of liver resection,or pathological T and N staging(P>0.05).Preoperatively(1 day before surgery),the levels of C-reactive protein(CRP),malondialdehyde(MDA),superoxide dismutase(SOD),white blood cell(WBC)count,alanine aminotransferase(ALT),and aspartate aminotransferase(AST)were comparable between the two groups(P>0.05).On postoperative days 1 and 3,the laparoscopic group had significantly lower levels of CRP,MDA,WBC count,ALT,and AST,and significantly higher SOD levels,compared with the open group(P<0.05).Conclusion Laparoscopic radical cholecystectomy achieves equivalent lymph node dissection efficacy to open surgery in patients with early-stage gallbladder cancer.Additionally,it offers the advantages of reduced intraoperative blood loss,faster postoperative recovery,and attenuated systemic stress response.Thus,laparoscopic radical cholecystectomy is a safe and feasible option for early-stage gallbladder cancer in high-volume,experienced hepatobiliary surgery centers.
郝龙;尹杰;蔡健开;沙洪存
宁波市鄞州区第二医院肝胆外科,浙江 宁波 315000宁波市鄞州区第二医院肝胆外科,浙江 宁波 315000宁波市鄞州区第二医院肝胆外科,浙江 宁波 315000宁波市鄞州区第二医院肝胆外科,浙江 宁波 315000
医药卫生
胆囊癌根治术腹腔镜手术开腹术式应激反应
radical cholecystectomylaparoscopyopen operationstress response
《肝胆胰外科杂志》 2026 (4)
255-259,5
宁波市鄞州区科学技术项目(2022AS068).
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