关键词: 腹腔镜下胆囊切除术, 淋巴结清扫, 原发性胆囊癌, 安全性

Abstract: Objective  To analyze the efficacy, safety, and survival of laparoscopic cholecystectomy (LC) combined with lymph node dissection in the treatment of elderly primary gallbladder cancer.Methods 59 elderly patients with primary gallbladder cancer who underwent open cholecystectomy combined with lymph node dissection from January 2018 to July 2021 were selected as the control group, and 59 elderly patients with primary gallbladder cancer who underwent LC combined with lymph node dissection were selected as the study group. The clinical efficacy, perioperative indicators, and T cell subsets were compared between the two groups CD4⁺、CD4⁺/CD8⁺]、 Quality of life (SF-36). Results  The difference in recent treatment effectiveness between the research group and the control group is relatively small,(94.0% vs. 72.5%,χ2=0.209,P=0.648).The time required for lymph node dissection was (39.27±5.63)min and surgery time was (235.16±31.37)min in the study group,which was longer than that in the control group [(35.61±4.75)min and (194.59±30.82)min（P<0.05）.In the study group,the intraoperative bleeding volume was (32.63±5.42)ml and first exhaust time was (3.18±0.72)d,gastrointestinal function recovery time was (3.98±1.04)d,and hospitalization time  was (6.24±1.25)d,which were shorter than those in the control group [(61.27±7.85)ml,(4.02±0.83)d,(4.65±1.18)d,(10.41±2.18)d,respectively,(P<0.05)].After surgery,the levels of CD3⁺(16.52%±5.24%),CD4⁺(15.79%±3.83%),and CD4⁺/CD8⁺(0.47%±0.11%) in the study group were higher than those in the control group (13.74%±4.30%,10.83%±3.14% and 0.29%±0.05%) (P<0.05).One month after surgery,the total quality of life score (SF-36) of the observation group (90.86±3.75) was higher than that of the control group (86.85±3.14) (P<0.05).The incidence of complications in the study group was lower than that in the control group (7.01% vs. 23.73%,χ2=4.627,P<0.05).The median survival time of the study group was (13.8±1.50)months,which was significantly higher than that of the control group [(12.5±1.25)months,P>0.05].Conclusion  LC combined with lymph node dissection is a safe and effective treatment for elderly primary gallbladder cancer,without affecting long-term prognosis and survival.

Key words: laparoscopic cholecystectomy, lymph node dissection, primary gallbladder carcinoma in the elderly, security