摘要目的:探讨腹腔镜手术在胆囊癌患者中应用的安全性和治疗效果。方法:回顾性分析2012年1月至2022年9月北京协和医院收治的197例胆囊癌患者的临床和病理学资料。男性86例，女性111例，年龄（64.4±9.8）岁（范围：35~89岁）。根据手术方式不同将患者分为腹腔镜组（53例）和开腹组（144例）。应用倾向性评分匹配法对两组患者的基本信息进行匹配，并对匹配后患者的临床资料和预后进行比较。定量资料按照是否符合正态分布分别用 t检验和Mann-Whitney U检验进行组间比较；分类资料用χ 2检验或Fisher确切概率法进行组间比较。应用Kaplan-Meier曲线对两组患者的生存率进行分析，并采用Log-rank检验进行组间比较。 结果:腹腔镜组和开腹组各有48例患者匹配成功。两组患者在一般情况、是否合并胆囊结石、是否接受肝脏部分切除、肿瘤分期等方面保持平衡（ P值均>0.05）。匹配后腹腔镜组患者手术时间更短（ t=-3.987， P<0.01），术中出血量更少（ Z=-4.862， P<0.01），总住院时间（ Z=-5.009， P<0.01）和术后住院时间（ Z=-5.412， P<0.01）更短。17例患者发生术后并发症，按照Clavien-Dindo并发症分级系统，Ⅰ级4例、Ⅱ级11例、Ⅲa级1例、Ⅲb级1例。所有并发症经积极治疗后好转。截至2022年12月，96例患者获得24（36）个月（范围：3~130个月）的随访，56例（58.3%）无瘤生存，7例（7.3%）带瘤生存，33例（34.4%）死亡。根据Kaplan-Meier生存曲线，腹腔镜组和开腹组患者在无瘤生存时间（χ 2=0.399， P=0.528）和总体生存时间（χ 2=0.672， P=0.412）的差异均无统计学意义。 结论:腹腔镜手术治疗有选择的胆囊癌患者较为安全和有效，不会增加术后并发症，患者预后与开腹手术类似。

abstractsObjective:To examine the efficacy and safety of laparoscopic surgery for gallbladder carcinoma.Methods:Data from 197 gallbladder carcinoma patients admitted to Peking Union Medical College Hospital between January 2012 and September 2022 were analyzed retrospectively. There were 86 males and 111 females,with an age of (64.4±9.8)years(range: 35 to 89 years). The patients were divided into laparoscopic group( n=53) and open group( n=144) according to different surgical methods. The general information of the two groups was matched by propensity score matching,and the clinical data and the prognosis were compared between the two groups. Categorical variables were analyzed using χ 2 test or Fisher′s exact test,as appropriate. Continuous variables with and without normal distribution were analyzed using the t-test and the Mann-Whitney U test,respectively. Kaplan-Meier curves with Log-rank test were used to analyze the cumulative survival rates. Results:Forty-eight pairs of patients were matched successfully. There were no differences in general information,cholecystolithiasis,partial hepatectomy,and tumor stage between the two groups(all P>0.05). The laparoscopic group had a shorter operation time( t=-3.987, P<0.01),less bleeding( Z=-4.862, P<0.01),a shorter total( Z=-5.009, P<0.01) and postoperative( Z=-5.412, P<0.01) hospital stay. Seventeen patients had postoperative complications. According to the Clavien-Dindo system,there were 4,11,1,and 1 patient with grade Ⅰ,Ⅱ,Ⅲa,and Ⅲb,respectively. All complications improved after active treatment. After a follow-up( M(IQR)) of 24(36) months(range: 3 to 130 months),56 patients(58.3%) survived without tumor,7 patients(7.3%) survived with tumor,and 33 patients(34.4%) died. According to the Kaplan-Meier curves,there was no significant difference between the laparoscopic and open groups in disease free(χ 2=0.399, P=0.528) and overall(χ 2=0.672, P=0.412) survival rates. Conclusions:Laparoscopic surgery is safe and effective in selected patients with gallbladder carcinoma. It can reduce surgical trauma and improve patient recovery without increasing complication. Its prognosis is similar to that of open surgery.