摘要
目的评价侧方淋巴结清扫在低位直肠癌根治术中的应用价值。方法将2004年7月至2010年12月在中南大学湘雅医院行直肠癌根治术的152例低位直肠癌患者随机分为两组,观察组(67例)行全直肠系膜切除(TME)+侧方淋巴结清扫,对照组(85例)行单纯TME,比较两组的平均手术时间、术中失血量,局部复发率、远处转移率及3年生存率,术后排尿功能及性功能等指标。结果观察组的平均手术时间、术中失血量分别为(263.2±48.4)min、(535.3±62.7)ml,对照组分别为(207.1±45.5)min、(409.5±48.3)ml,两组比较差异有统计学意义(P<0.05),观察组的局部复发率、远处转移率及3年生存率分别为8.20%、6.56%、83.61%,对照组分别为21.74%、20.29%、65.22%,差异有统计学意义(P<0.05),两组的术后排尿功能及性功能指标相比,差异无统计学意义(P>0.05),低分化腺癌及黏液腺癌的侧方淋巴转移率分别为33.33%、40.00%,高于高、中分化腺癌的7.14%,差异有统计学意义(P<0.05)。结论侧方淋巴结清扫能安全有效地改善低位直肠癌根治术的治疗效果,提高生存率,改善生存质量,应常规用于低分化腺癌、黏液腺癌者。
Objective To evaluate the clinical value of lateral lymphadenectomy in radical resection of low rectal carcinoma.Methods 152 patients with lower rectal carcinoma,who underwent radical resection in our hospital from July 2004 to December 2010,were randomly divided into two groups.In the experiment group,total mesorectum excision(TME) combined with lateral lymphadenectomy was performed in 67 patients.In the control group,only TME was performed in 85 patients.A comparative analysis was subsequently completed between the two groups in the average operative duration,intraoperative blood loss,local recurrence rate,distant metastasis rate,3-year survival rate and postoperative urinary and sexual function,etc.Results The statistical significance existed between the experiment group and control group in the average operative duration[(263.2±48.4) min vs. (207.1±45.5) min] and intraoperative blood loss [(535.3±62.7) ml vs.(409.5±48.3) ml],respectively(P<0.05).The local recurrence rate and distant metastasis rate in the experiment group(8.20%,6.56%) were lower than those in the control group(21.74%,20.29%) and 3-year survival rate in the former(83.61%) was superior to that in the latter(65.22%),respectively(P<0.05).There were no statistically significant differences between the two groups in postoperative urinary and sexual function indexes(P>0.05).The lateral lymphaden metastasis rates in the patients pathologically diagnosed as poorly differentiated adenocarcinoma(33.33%) and mucinous adenocarcinoma(40.00%) were higher than those in the patients pathologically diagnosed as well-differentiated adenocarcinoma(P<0.05).Conclusions Lateral lymphadenectomy can improve the curative effect and postoperative life quality safely and effectively,increase the survival rate in the radical resection of low rectal carcinoma,should be routinely applied in the patients with poorly differentiated adenocarcinoma and mucinous adenocarcinoma.
出处
《中华临床医师杂志（电子版）》
CAS
2011年第11期3141-3145,共5页
Chinese Journal of Clinicians(Electronic Edition)
