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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 39 -42. doi: 10.3877/cma.j.issn.1674-3946.2021.01.012

所属专题: 文献

论著

中低位直肠癌TME手术结合侧方淋巴结清扫的临床意义研究
胡俊君1,(), 李社方1, 夏春明1   
  1. 1. 430071 武汉,武汉市第七医院外科
  • 收稿日期:2020-03-13 出版日期:2021-02-10
  • 通信作者: 胡俊君

Clinical significance of Total Mesorectal Excision combined with lateral lymph node dissection for middle/low rectal cancer

Junjun Hu1,(), Shefang Li1, Chunming Xia1   

  1. 1. Department of Surgery, the 7th Hospital of Wuhan city, Hubei 430071, China
  • Received:2020-03-13 Published:2021-02-10
  • Corresponding author: Junjun Hu
  • Supported by:
    Scientific research project of Hubei health and Family Planning Commission(15ZD053)
引用本文:

胡俊君, 李社方, 夏春明. 中低位直肠癌TME手术结合侧方淋巴结清扫的临床意义研究[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(01): 39-42.

Junjun Hu, Shefang Li, Chunming Xia. Clinical significance of Total Mesorectal Excision combined with lateral lymph node dissection for middle/low rectal cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(01): 39-42.

目的

研究中低位直肠癌行全直肠系膜切除术(TME)结合侧方淋巴结清扫(LLND)的临床意义。

方法

回顾性分析2013年1月至2014年12月73例中低位直肠癌患者资料,根据不同术式将其分为联合组及TME组两组。TME组患者34例,联合组患者39例,行TME+ LLND。临床数据分析使用统计学软件SPSS 24.0,围术期指标等计量资料采用(±s)表示,独立样本t检验;术后并发症等计数资料采用χ2检验;用K-M法绘制生存曲线,并采用Log-rank检验分析生存率差异。P<0.05为检验标准。

结果

TME组手术时间及手术出血量均较联合组少(P<0.05);两组术后排气时间、术后住院时间、并发症发生率、性功能障碍、排尿障碍及术后1年、3年的局部复发率比较,差异均无统计学意义(P>0.05);联合组术后5年的局部复发率为7.7%,低于TME组的26.5%, P<0.05);TME组术后1、3、5年生存率分别为82.4%、61.8%、52.9%;联合组术后1、3、5年生存率分别为92.3%、82.1%、74.4%,联合组术后生存率优于TME组,差异有统计学意义(P<0.05)。

结论

中低位直肠癌行TME+ LLND术可提高患者的远期生存率,且在手术技巧和精细操作下,保证患者术后生活质量,有积极的临床意义。

Objective

To investigate the clinical significance of Total Mesorectal Excision (TME) combined with lateral lymph node dissection for middle/low rectal cancer.

Methods

From January 2013 to December 2014, retrospective analysis of clinical data was performed in 73 patients with middle/low rectal cancer. According to different surgical methods, 73 patients were divided into the combined group (39 cases) and the TME group (34 cases). Statistical analysis of clinical data were performed by using SPSS 24.0 software. Measurement data such as perioperative indicators were expressed as (±s) and examined by using independent sample t-test. Count data such as postoperative complications were examined by using χ2 test. The survival was analyzed by using K-M method and log-rank test. A P value of < 0.05 was considered as significant difference.

Results

The operation time and intraoperative bleeding volume in the TME group were less than those in the combined group respectively, with significant difference (P<0.05). There was no significant difference between two groups in terms of the postoperative exhaust time, postoperative hospitalization, the incidence of complications, incidence of sexual dysfunction or dysuria and local recurrence rate of 1 and 3 years after operation (P>0.05). The 5-year local recurrence rate of the combined group was 7.7%, which was lower than 26.5% in the TME group (P<0.05); The 1-year, 3-year and 5-year survival of TME group were 82.4%, 61.8% and 52.9%, while the 1-year, 3-year and 5-year survival of combined group were 92.3%, 82.1% and 74.4% respectively, and better survival were achieved in combined group with significant difference (P<0.05).

Conclusion

TME+ LLND surgery could improve the long-term survival of patients with middle/low rectal cancer, and it has positive clinical significance to ensure the quality of life of patients after operation with refined skills and operation.

表1 73例中低位直肠癌患者不同术式两组患者一般临床资料[(±s),例]
表2 73例中低位直肠癌患者不同术式两组患者围手术期指标(±s)
表3 73例中低位直肠癌患者不同术式两组患者术后随访情况[例(%)]
图1 73例中低位直肠癌患者不同术式两组患者术后总生存率比较
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