Clinical exploration of laparoscopic liver resection for intrahepatic cholangiocarcinoma of 58 cases / 国际外科学杂志

ABSTRACT

Objective To explore the safety and feasibility of laparoscopic liver resection in the treatment of intrahepatic cholangiocarcinoma (ICC).Methods The retrospective study was adopted.The clinical data of 58 patients with ICC who underwent laparoscopic liver resection in the Department of Hepatobiliary Minimally Invasive Surgery of the First Affiliated Hospital of Hu'nan Normal University were collected From January 2016 to December 2018.Among them,34 patients were males and 24 were females,aged from 34 to 71 years with a median age of 54 years.Observation indicators(1) Surgical treatmentsurgical methods,operation time,intraoperative blood loss,intraoperative blood transfusion rate,intraoperative hepatic portal blocking time,conversion rate,postoperative complications,postoperative hospital stay.(2) Postoperative pathological conditions.(3) Followup.Follow-up visits were conducted using an outpatient clinic and telephone to understand patient survival after surgery.The follow-up period was until June 2019.Measurement data with normal distribution were expressed as (Mean ± SD),count data was expressed as frequency and percentage.Results A total of 58 patients were included in this study,of which 48 patients underwent laparoscopic radical surgical resection of intrahepatic cholangiocarcinoma and 10 patients underwent laparoscopic conversion to laparotomy.(1) Surgical treatmentlaparoscopic resection of the left liver (segments Ⅱ,Ⅲ and Ⅳ),laparoscopic resection of the right liver (segments Ⅴ,Ⅵ,Ⅶ and Ⅷ),laparoscopic resection of the right posterior lobe (segments WⅥ and Ⅶ),laparoscopic extended resection of the right posterior lobe,laparoscopic resection of the middle lobe (Ⅳ,Ⅴ and Ⅷ),laparoscopic resection of the Ⅴ and Ⅵ,laparoscopic resection of the left liver (segments Ⅱ,Ⅲ and Ⅳ)combined with the caudate lobe (segments Ⅰ and Ⅸ),laparoscopic extended left hemihepatectomy,laparoscopic resection of the Ⅵ,laparoscopic resection of the Ⅶ and Ⅷ,laparoscopic resection of the left lateral lobe (segments Ⅱ and Ⅲ) and laparoscopic resection of the right hepatic mass;operation time(320.38 ± 107.68) min;intraoperative blood loss(262.34 ± 76.06);intraoperative blood loss0 (0/58);Intraoperative hepatic portal occlusion time(48 ± 15) min,the conversion rate was 17.2％ (10/58);the incidence of postoperative biliary fistula was 6.8％ (4/58),and the patient was discharged after conservative treatment and unobstructed drainage (T-tube vacuum suction);the postoperative gastrointestinal recovery time was (1.84 ± 0.57) d;no other serious complications occurred.Postoperative hospital stay(9.34 ± 3.39) d;there were no deaths and unplanned surgeries during the perioperative period.(2) Pathological conditions32 cases received lymph node dissection during the operation,and 26 cases showed cholangiocarcinoma without lymph node dissection;pathological examination showed that the pathological reports of all tumor margins were negative,and 4 cases showed lymph node dissection and positive lymph node metastasis.(3) Follow-up results:of the 58 patients with ICC,49 were followed up for 6 to 36 months.The tumor survival time was (4 to 36) months.28 patients survived without tumor.17 patients had intrahepatic metastasis with multiple lymph node metastasis.4 patients were treated with microwave ablation after intrahepatic metastasis was found.9 patients were lost to follow-up.Conclusion Laparoscopic treatment of intrahepatic cholangiocarcinoma is safe and feasible in experienced centers.