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中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (05) : 417 -421. doi: 10.3877/cma.j.issn.2095-2015.2024.05.007

论著

以筋膜导向解剖入路的直肠癌侧方淋巴结清扫在男性直肠癌患者全直肠系膜切除术中的疗效
李泽航1, 雷德桥1, 陈贵进1, 王长征1, 谢正勇1,()   
  1. 1. 510010 广州,中国人民解放军南部战区总医院普通外科
  • 收稿日期:2023-12-19 出版日期:2024-10-01
  • 通信作者: 谢正勇

Curative effect of lateral lymph node dissection through fascia-oriented anatomical approach in male patients with rectal cancer during total mesorectal excision

Zehang Li1, Deqiao Lei1, Guijin Chen1, Changzheng Wang1, Zhengyong Xie1,()   

  1. 1. Department of General Surgery, General Hospital of The PLA Southern Theater Command, Guangzhou 510010, China
  • Received:2023-12-19 Published:2024-10-01
  • Corresponding author: Zhengyong Xie
引用本文:

李泽航, 雷德桥, 陈贵进, 王长征, 谢正勇. 以筋膜导向解剖入路的直肠癌侧方淋巴结清扫在男性直肠癌患者全直肠系膜切除术中的疗效[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 417-421.

Zehang Li, Deqiao Lei, Guijin Chen, Changzheng Wang, Zhengyong Xie. Curative effect of lateral lymph node dissection through fascia-oriented anatomical approach in male patients with rectal cancer during total mesorectal excision[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 417-421.

目的

探讨全直肠系膜切除术(TME)术中应用以筋膜导向解剖入路的直肠癌侧方淋巴结清扫术(LLND)在男性直肠癌患者中的治疗效果。

方法

选取2017年1月至2020年6月在中国人民解放军南部战区总医院就诊的男性直肠癌患者80例,采用意向性治疗分析方法,根据患者意向分配接受TME术中应用血管导向解剖入路的LLND治疗的患者38例为对照组,接受TME术中应用以筋膜导向解剖入路的LLND治疗的患者42例为观察组。比较两组患者手术相关指标、术后恢复情况、术后功能异常、术后并发症。出院后定期进行随访,采用结直肠癌生活质量专用量表(EORTC QLQ-CR38)评价患者术前及术后1、3、6个月的生活质量,统计术后无进展生存率。

结果

观察组与对照组手术时间、术中出血量无统计学差异(P>0.05),清扫淋巴结数量多于对照组(P<0.05)。两组术后首次通气时间、首次下床活动时间、住院时间均无统计学差异(P>0.05);术后并发症(腹腔感染、吻合口瘘、尿潴留、尿管损伤、切口感染)发生率无统计学差异(P>0.05);术后排尿功能及性功能异常发生率无统计学差异(P>0.05)。术后3个月和6个月观察组患者EORTC QLQ-CR38评分高于对照组(P<0.05);观察组术后无进展生存率高于对照组(P<0.05)。

结论

TME术中应用以筋膜导向解剖入路的直肠癌LLND在男性直肠癌患者中效果显著,可提高淋巴结清扫数量,延长患者术后生存期。

Objective

To explore the curative effect of lateral lymph node dissection (LLND) through fascia-oriented anatomical approach in male patients with rectal cancer during total mesorectal excision (TME).

Methods

A total of 80 male patients with rectal cancer treated in General Hospital of The PLA Southern Theater Command were enrolled between January 2017 and June 2020. According to different intentions, they were divided into control group (38 cases, LLND through vessel-oriented anatomical approach) and observation group (42 cases, LLND through fascia-oriented anatomical approach). The surgical related indexes, postoperative recovery, postoperative function abnormalities and postoperative complications were compared between the two groups. All underwent regular follow-up after discharge. Before surgery, at 1 month, 3 months and 6 months after surgery, quality of life was evaluated by the Europe Organization for Research and Treatment of Cancer quality of life questionaire-colorectal 38 (EORTC QLQ-CR38). The postoperative progression-free survival rates in both groups were analyzed.

Results

There was no significant difference in operation time or intraoperative blood loss between the two groups (P>0.05). The number of dissected lymph nodes in observation group was more than that in control group (P<0.05). There was no significant difference in first ventilation time, leaving bed time or hospitalization time between the two groups (P>0.05). There was no significant difference in the incidence of postoperative complications (abdominal infection, anastomotic fistula, urinary retention, urinary duct injury, incision infection) between the two groups (P>0.05). There was no significant difference in the incidence of urinary dysfunction and sexual dysfunction between the two groups (P>0.05). At 3 and 6 months after surgery, EORTC QLQ-CR38 scores in observation group were higher than those in control group (P<0.05), and postoperative progression-free survival rate was slightly higher than that in control group (P<0.05).

Conclusion

The application effect of LLND through fascia-oriented anatomical approach is significant for male patients with rectal cancer during TME, which can increase number of dissected lymph nodes and prolong postoperative survival.

表1 两组患者手术相关指标比较(±s
表2 两组患者术后恢复相关指标比较(±s
表3 两组患者术后并发症发生情况比较[例(%)]
表4 两组患者术后功能异常情况比较[例(%)]
表5 两组患者EORTC QLQ-CR38评分情况比较(±s
图1 两组患者术后无进展生存分析
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