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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 35 -38. doi: 10.3877/cma.j.issn.1674-3946.2018.01.012

所属专题： 经典病例； 文献；

论著

腹腔镜侧方淋巴结清扫术治疗中低位直肠癌48例疗效分析
郭校锡1,†(), 邓建中1, 林义办1, 李朝阳1, 梁姗姗1, 冯结兰1, 伍巧玲1   
  1. 1. 528000　广东佛山市第一人民医院
  • 收稿日期:2017-11-08 出版日期:2018-02-26
  • 通信作者: 郭校锡

Clinical analysis of laparoscopic lateral lymph node dissection in the treatment of mid-low rectal cancer

Xiaoxi Guo1,†(), Jianzhong Deng1, Yiban Lin1, Zhaoyang Li1, Shanshan Liang1, Jielan Feng1, Qiaoling Wu1   

  1. 1. The First People Hospital of Foshan, Guangdong 528000, China
  • Received:2017-11-08 Published:2018-02-26
  • Corresponding author: Xiaoxi Guo
  • About author:
    Corresponding author: Guo Xiaoxi, Email:
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郭校锡, 邓建中, 林义办, 李朝阳, 梁姗姗, 冯结兰, 伍巧玲. 腹腔镜侧方淋巴结清扫术治疗中低位直肠癌48例疗效分析[J/OL]. 中华普外科手术学杂志(电子版), 2018, 12(01): 35-38.

Xiaoxi Guo, Jianzhong Deng, Yiban Lin, Zhaoyang Li, Shanshan Liang, Jielan Feng, Qiaoling Wu. Clinical analysis of laparoscopic lateral lymph node dissection in the treatment of mid-low rectal cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2018, 12(01): 35-38.

目的

评估保留自主神经的腹腔镜侧方淋巴结清扫术在治疗中低位直肠癌的疗效。

方法

回顾分析2011年6月至2016年12月接受腹腔镜侧方淋巴结清扫手术的48例直肠癌患者的临床资料，记录患者的手术相关情况、术后功能恢复情况及影响侧方淋巴结转移的肿瘤病理学因素，分析患者的预后情况并作统计学分析。数据采用SPSS 19. 0统计软件包分析，术中术后计量资料用均数±标准差表示，采用t检验；患者的临床特点及病理因素与侧方淋巴结转移的关系，采用χ2检验，P<0.05表示差异具有统计学意义。

结果

手术时间为(245.7±46.7) min，术中出血量为(223.7±66.0) ml，平均住院时间(8.3±1.4) d、术后排气时间(3.8±0.8) d。13例(27.1%)患者出现短暂轻—中度排尿功能障碍，23例(47.9%)出现性功能障碍。41例患者发生周围淋巴结转移，15例(31.3%)侧方淋巴结转移；共清扫出648枚淋巴结，阳性304枚，侧方淋巴结转移33枚(5.1%)，转移率与侧方淋巴结直径、病理类型及TNM分期相关。随访40个月，36例患者术后生存，15例局部复发，12例死亡；3例患者带瘤生存，33例无瘤生存；有侧方淋巴结转移组患者的预后比无侧方转移患者差。

结论

腹腔镜侧方淋巴结清扫术治疗中低位直肠癌中是安全、可行的，可有效改善预后；保留自主神经能有效保护性功能、排尿功能。

关键词: 直肠肿瘤, 腹腔镜检查, 淋巴结切除术, 自主神经通路
Objective

To evaluate the efficacy of laparoscopic lateral lymph node dissection with the preservation of the autonomic nerve in the treatment of middle and low rectal cancer.

Methods

The clinical data of 48 patients with rectal cancer who underwent laparoscopic lateral lymph node dissection from June 2011 to December 2016 were retrospectively analyzed. The operation, postoperative recovery and prognosis were recorded. The prognosis of the patients was analyzed. The data were analyzed by SPSS 19.0 statistical software package. The postoperative measurement data were expressed with mean standard deviation and by t test. The relationship between clinical characteristics and pathological factors and lateral lymph node metastasis was analyzed by chi square test. P<0.05 indicated that the difference was statistically significant.

Results

The operating time was (245.7±46.7) min, and mean blood loss was (223.7±66.0) ml. The average hospital stay time and exhaust time were (8.3±1.4) days and (3.8±0.8) days respectively. 13(27.1%) cases were suffered from transient mild-moderate urinary dysfunction, and 23 (47.9%) cases were developed sexual dysfunction. Of the 48 patients, lymph node metastasis was found in 41 patients, and lateral lymph node metastasis was found in 15 cases. A total of 648 lymph nodes were cleared, in which 304 mesenteric lymph nodes and 33(5.1%) lateral lymph node were positive. The lateral lymph node metastasis was related to the diameter of lateral lymph node, the pathological type and the TNM stage of the tumor. Followed-up 40 months, a total of 36 cases survived, 15 cases developed local recurrence, 12 cases died from metastasis, 3 cases lived with tumor, and 33 cases were disease-free survival. The patients with lateral lymph node metastasis and the group of positive lateral lymph node had a poor prognosis than the other patients.

Conclusion

Laparoscopic lateral lymph node dissection for patients with mid-low rectal cancer is safe and feasible, and it can improve the prognosis. Autonomic nerve-preserving surgery can effectively protect sexual function and urinary function.

Key words: Rectal Neoplasms, Laparoscopy, Lymph Node Excision, Autonomic Pathways
表1 48例中低位直肠癌患者行根治性切除＋侧方淋巴清扫病理因素对侧方淋巴结的影响
病理因素 临床资料 例数 侧方转移例(%) χ2值 P值
性别 男 26 9(34.6) 0.30 0.584
? 女 22 6(27.3)
年龄 >60岁 27 8(29.6) 0.02 0.784
? <60岁 21 7(33.3)
大体类型 肿块型 18 5(27.8) 0.16 0.688
? 浸润型 30 10(33.3)
病理类型 低分化、黏液腺癌 12 9(75.0) 12.61 0.000
? 高、中分化腺癌 36 6(16.7)
位置 距肛缘>5 cm 20 6(30.0) 0.02 0.875
? 距肛缘<5 cm 28 9(32.1)
侧方淋巴结直径 >5～<10 mm 22 3(13.6) 5.96 0.015
? >10 mm 26 12(46.2)
TMN分期 pⅢB期 12 1(8.3) 249.23 0.016
? pⅢC期 29 14(48.3)
表2 48例中低位直肠癌患者行侧方淋巴清扫后有无侧方淋巴结转移对预后的影响[例(%)]
? 例数 局部复发 5年总体生存 5年无瘤生存
有侧方淋巴结转移 15 8(53.3) 8(53.3) 7(46.7)
无侧方淋巴结转移 33 7(21.2) 28(84.8) 26(78.8)
χ2值 ? 3.57 3.91 3.57
P值 ? 0.026 0.019 0.026
表3 48例中低位直肠癌患者新辅助治疗后侧方淋巴结大小对预后的影响
侧方淋巴结大小(mm) 例数 局部复发(例，%) 5年总体生存(例，%) 5年无瘤生存(例，%)
>5～<10 22 3(13.6) 20(90.9) 19(86.4)
≥10 26 12(46.2) 16(61.5) 14(53.8)
χ2值 ? 5.86 5.48 5.86
P值 ? 0.015 0.019 0.015
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