摘要目的:比较腹腔镜和开腹胆囊癌根治术的近期临床疗效及远期预后。方法:回顾性分析2010年1月至2020年12月于浙江省人民医院肝胆胰外科接受胆囊癌根治术的133例胆囊癌患者的临床及术后随访资料。其中80例完成腹腔镜胆囊癌根治术（腹腔镜组），男性23例，女性57例，年龄［ M（IQR）］66.0（12.8）岁（范围：28.0~82.0岁）；53例完成开腹胆囊癌根治术（开腹组），男性8例，女性45例，年龄63.0（6.0）岁（范围：45.0~80.0岁）。腹腔镜组与开腹组在年龄、性别、体重指数、术前白蛋白、术前总胆红素、N分期、脉管侵犯、神经侵犯及肿瘤分化的差异均无统计学意义（ P值均>0.05），而术前CA19-9（ Z=-2.955， P=0.003）、术前ALT水平（ Z=-2.801， P=0.031）、T分期分布（χ 2=19.110， P=0.007）的差异均有统计学意义。定量资料的比较采用非参数检验，分类资料的比较采用χ 2检验或Fisher确切概率法。 结果:两组患者在手术时间、淋巴结清扫数目、阳性淋巴结数目、术中胆囊破裂，术后胆瘘、腹腔出血、腹腔感染发生率，术后30 d和90 d病死率、切口种植及术后腹腔转移方面的差异均无统计学意义（ P值均>0.05）；腹腔镜组术中出血量［100.0（200.0）ml比400.0（250.0）ml］（ Z=-5.260， P<0.01）、引流管留置时间［6.0（3.8）d比7.0（4.0）d］（ Z=-3.351， P=0.001）及术后住院时间［8.0（5.0）d比14.0（7.5）d］（ Z=-6.079， P<0.01）优于开腹组。腹腔镜组1、3年总体生存率分别为63.6%、49.6%，开腹组1、3年总体生存率分别为37.7%、12.9%，差异有统计学意义（ P<0.01）；腹腔镜组1、3年无进展生存率分别为79.4%、54.1%，开腹组1、3年无进展生存率分别为55.7%、37.6%，差异有统计学意义（ P<0.01）。对T1b~T2期及T3期胆囊癌进行亚组分析，结果显示，两组术后总体生存率及无进展生存率的差异均无统计学意义（ P值均>0.05）。 结论:腹腔镜胆囊癌根治术可取得与开腹手术类似的近期临床结局和长期预后，且具有手术创伤小及术后恢复快的优势。

abstractsObjective:To compare the short-term efficacy and long-term prognosis of laparoscopic and laparotomy radical resection for gallbladder cancer(GBC).Methods:From January 2010 to December 2020,the clinical data and survival information for 133 patients who underwent radical resection of GBC at the Department of Hepatopancreatobiliary Surgery,Zhejiang Provincial People′s Hospital,were retrospectively collected. Eighty patients(23 males and 57 females) underwent laparoscopic radical resection and had a median age( M(IQR)) of 66.0(12.8)years(range:28.0 to 82.0 years). Fifty-three patients(45 males and 8 females) who received laparotomy were 63.0(6.0)years old(range:45.0 to 80.0 years old). There were no significant differences in age,gender,body mass index,preoperative albumin,preoperative total bilirubin,N stages,vascular invasion,peri-neural invasion or tumor differentiation between the laparoscopic and laparotomy group(all P>0.05). But there were significant differences in preoperative CA19-9( Z=-2.955, P=0.003), preoperative ALT level( Z=-2.801, P=0.031) and T stage (χ 2=19.110, P=0.007) between the two groups. A non-parametric test was used for quantitative data. χ 2 test or Fisher exact probability method was used for count data. Results:Patients in the laparoscopic group did not differ from those in the laparotomy group in terms of length of operation,number of lymph node yield,number of positive lymph nodes,the incidence of intraoperative gallbladder rupture,incidence of postoperative bile leakage,abdominal bleeding or abdominal infection,30-day mortality,90-day mortality, the incidence of incision implantation or peritoneal cavity metastasis(all P>0.05). Patients in the laparoscopic group showed less intraoperative bleeding(100.0(200.0)ml vs. 400.0(250.0)ml)( Z=-5.260, P<0.01),fewer days with drainage tube indwelling(6.0(3.8)days vs. 7.0(4.0)days)( Z=-3.351, P=0.001), and fewer postoperative days in hospital(8.0(5.0)days vs. 14.0(7.5)days)( Z=-6.079, P<0.01) than those in the laparotomy group. Patients in the laparoscopic group displayed better overall survival ( P<0.01) and progression-free survival ( P<0.01). Subgroup analysis for GBC of T1b-T2 and T3 stages revealed comparable overall survival and progression-free survival between the laparoscopic and laparotomy groups ( P>0.05). Conclusions:Laparoscopic radical resection can achieve long-term survival for GBC comparable to that with open surgery. Laparoscopic radical resection has advantages over open surgery regarding surgical trauma and postoperative recovery.