ABSTRACT
Objective:To compare between laparoscopic and open pancreaticoduodenectomy in the treatment of distal cholangiocarcinoma.Methods:The clinical data of laparoscopic pancreaticoduodenectomy (LPD group, n=101) and open pancreaticoduodenectomy (OPD group, n=99) in patients with distal cholangiocarcinoma who underwent pancreaticoduodenectomy at Hunan people's Hospital from Jan 2015 to Dec 2019 were analyzed retrospectively. The operation time, intraoperative blood loss, number of lymph node dissection, R 0 resection rate, postoperative hospital stay, postoperative complications and overall survival rate were compared between the two groups. Results:The operation time was (475.0±90.7) min and (444.8±63.3) min, the intraoperative blood loss was (350.9±397.9) ml and (546.7±642.9) ml, the postoperative hospital stay was (11.5±4.7) d and (13.3±5.1) d, the differences were statistically significant ( P<0.05).The number of lymph node dissection was 14.8±3.0 and 15.4±2.4, the R 0 resection rate was 93.1% and 96.0%, respectively, and there was no significant difference ( P>0.05). There was no significant difference in the incidence of residual complications ( P>0.05). During the follow-up of 5-64 months, the OS of 1, 3 and 5 years in the two groups were 90.4%, 41.3%, 20.6% and 94.3%, 50.8% and 24.7%, respectively. ( P>0.05). Conclusions:LPD is safe and feasible in the treatment of distal cholangiocarcinoma, and its short-term curative effect, curative effect and long-term overall survival rate are similar to those of OPD.
ABSTRACT
Objective:To compare the safety and efficacy of laparoscopic versus open pancreaticoduodenectomy.Methods:The clinical data of 989 patients who underwent pancreaticoduodenectomy at Hunan People's Hospital from January 2015 to December 2019 were analyzed retrospectively. There were 349 patients in the laparoscopic pancreaticoduodenectomy (LPD) group and 640 patients in the open pancreaticoduodenectomy (OPD) group. Propensity score matching (PSM) was used to match the baseline data of the two groups at a 1: 1 ratio. Data including operation time, intraoperative bleeding, postoperative hospital stay, bile leakage, pancreatic fistula and wound infection were compared between the two groups.Results:After PSM, there were 345 patients in each of the 2 groups. When the LPD group was compared with the OPD group, there were no significant differences in postoperative mortality, reoperation, intraoperative blood transfusion, pancreatic fistula, bile leakage, abdominal hemorrhage, abdominal abscess, severe complications, and pulmonary complication rates. The number of lymph node dissected, R 0 resection and overall survival rates between the two groups were also not significantly different ( P>0.05). However, the operation time of the LPD group (478.2±91.3) min was significantly longer than that of the OPD group (410.8±62.0) min ( P<0.05). On the other hand, the postoperative hospitalization time (10.8±4.3) d, intraoperative bleeding (322.0±362.6) ml, wound infection rate 1.2% (4/345) in the LPD group were significantly better than those in the OPD group [postoperative hospitalization time (12.5±7.9) d, intraoperative bleeding (478.8±570.2) ml, and wound infection rate 5.8% (20/345)] ( P<0.05) . Conclusion:LPD was safe and feasible, and it achieved similar curative effect as OPD.
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Objective To evaluate the efficacy and safety of percutaneous radiofrequency ablation combined with immunotherapy in the treatment of hepatocellular carcinoma .Methods A total of 124 patients with liver cancer were randomly divided into the two groups .60 cases in the control group were given immunity treatment alone ,while 64 cases in the observation group were treated by percutaneous radiofrequency ablation combined with immune therapy . The middle and long term curative effect of two groups was observed .Results After treatment,the tumor diameter, serum alpha fetoprotein (AFP) and carcino-embryonic antigen (CEA) levels in the two groups were significantly decreased(t=4.867,P=0.005;t=5.175,P=0.004;t=3.155,P=0.025;t=4.845,P=0.005;t=4.031,P=0.010;t=2.668,P=0.044),but the declining degree of the observation group was better than the control group (t=4.119,P=0.009;t=3.621,P=0.015;t=3.492,P=0.017).The total effective rates and disease control rates of the observation group were 53.1%,78.1%,which were significantly higher than 28.3%,46.7%in the control group (χ2 =11.290,P=0.010;χ2 =21.290,P=0.000).The 1-year,3-year,5-year survival rates of the observation group were 60.9%,31.3%,12.5%,those of the control group were 21.7%,5.0%,0.0%,the middle and long term sur-vival rates of the observation group were significantly higher than the control group (χ2 =21.935,P=0.000;χ2 =56.452,P=0.000;χ2 =40.516,P=0.000).No statistically significant differences in the CD 4+,CD8+,CD4+/CD8+, IL-12 and other indicators between the two groups before treatment ,but these indicators in the observation group were significantly improved after treatment (t =4.515,P =0.006;t =10.014,P =0.000;t =5.217,P =0.003). Conclusion Combination of percutaneous radiofrequency ablation and immunotherapy in the treatment of hepatocell-lular carcinoma has exact effect and with advantages of less adverse reaction , good safety , which can significantly improve the quality of life and survival rate of patients ,it has good clinical application value .