Comparison Of Curative Effect Of Laparoscopic And Open Surgery On Gallbladder Cancer

Objective:By comparing the intraoperative and postoperative indicators and survival conditions of laparoscopic and open radical gallbladder cancer surgery,To explore the safety,feasibility and short-term clinical efficacy of laparoscopic radical resection of gallbladder cancer.Methods:To retrospectively collect clinical medical records of 65 patients with radical gallbladder cancer surgery performed from January 2015 to January 2020 in the General Surgery Department of the 215 Hospital of Nuclear Industry of Shaanxi Province,Affiliated to Xi’an Medical College.All patients in the group received R0 resection and confirmed pathology after surgery,including 31 cases in the laparoscopic group and 34 cases in the laparotomy group.The intraoperative and postoperative indicators and survival conditions between the two groups were compared and analyzed.The Kaplan-Meier method was used to draw the survival curve and calculate the survival rate,the Log-rank test was used to compare the overall survival rate between the two groups,and the Z test was used to compare the 1-year cumulative survival rate between the two groups.Draw a learning curve and use the Moving average method(Moving average MA)for evaluation.Results:1.General information,baseline data such as gender,age,history of gallstones,preoperative of CA19-9 level,preoperative of CA125 level and preoperative total bilirubin among the laparoscopic group and the laparotomy group show no significant difference(P>0.05).2.Intraoperative and postoperative recovery: Compared with the traditional laparotomy group,the gastrointestinal function recovery time in the laparoscopic group was shorter[(2.58±0.77)d vs(3.26±1.23)d,P=0.010]、postoperative hospital stay is shorter[(10.03±3.47)d vs(11.48±2.23)d P=0.047]、intraoperative blood loss is lower[(284.84±61.57)ml vs(332.14±89.73)ml,P=0.017],significant statistical difference between the two groups(P<0.05);Other indexes included the number of lymph nodes[(6.19±2.68)vs(7.14±2.88),P=0.175)]、Postoperative complication rate [19.4%(6/31)vs23.5%(8/34)P=0.814]、Postoperative drainage tube removal time [(7.71±3.22)d vs(8.26±3.47)d P=0.529] are no significant statistical difference between the groups(P>0.05).3.Comparison of postoperative survival rates:no significant difference between the two groups(P=0.184),The 1-year cumulative survival rates of the laparoscopic group and the laparotomy group were respectively 84.4% and 74.4%,no significant difference between the two groups(P=0.543).4.In the TNM Ⅰ-Ⅱ subgroup,compared with the traditional laparotomy group,the recovery time of gastrointestinal function in the laparoscopic group was shorter [(2.29±0.87)d vs(3.07±0.49)d,P=0.004]、 postoperative hospital stay is shorter [(7.89±2.09)d vs(9.74±1.34)d P=0.017],significant statistical difference between the two groups(P<0.05);The 1-year cumulative survival rates of the laparoscopic group and the laparotomy group were respectively 87.5% and 83.3%,no significant difference between the two groups(P=0.370).5.In the TNM Ⅲsubgroup,compared with the traditional laparotomy group,the recovery time of gastrointestinal function in the laparoscopic group was shorter [(3.37±0.72)d vs(3.89±0.51)d,P=0.034];The 1-year cumulative survival rates of the laparoscopic group and the laparotomy group were respectively 66.7% and 64.6%,no significant difference between the two groups(P=0.413).Conclusions:Laparoscopy is safe and feasible for radical resection of gallbladder cancer.For gallbladder cancer after cholecystectomy,laparoscopic radical resection of gallbladder can achieve clinical results similar to open surgery.In the middle and early radical resection of gallbladder cancer,laparoscopic technology has the advantages of reducing intraoperative bleeding,speeding up postoperative gastrointestinal function recovery,and shortening postoperative hospital stay.Laparoscopic radical resection of gallbladder cancer is recommended to be carried out in clinical centers with skilled laparoscopic techniques,and its long-term therapeutic effect needs to be demonstrated in multi-center,randomized controlled studies.