中低位直肠癌腹腔镜与开放全系膜切除合并侧方淋巴结清扫围手术期临床分析

发布时间：2018-11-23 21:24

【摘要】：目的比较中低位直肠癌患者在腹腔镜与开放全直肠系膜切除术(TME)基础上行侧方淋巴结清扫的围手术期临床结果,以探讨腹腔镜盆腔淋巴结清扫术的可行性及安全性。方法对浙江省肿瘤医院同期16例腹腔镜及55例开放侧方淋巴结清扫术患者临床资料进行回顾性分析,比较了两组间围手术期手术时间、术中出血量、侧方淋巴结清扫数目、术后并发症及术后住院时间。结果腹腔镜组与开放组患者基础临床特征相似。两组患者均无围手术期死亡。腹腔镜组患者无中转开腹手术。腹腔镜组比开放组手术时间显著延长(218.6±71.6 min vs.181.3±57.9 min,P=0.035)、术中出血量显著减少(190.6±80.1 ml vs.344.9±295.2 ml,P=0.044)。腹腔镜组与开放组清扫的侧方淋巴结数目(9.8±6.1枚vs.11.0±9.7枚,P=0.642)、侧方淋巴结转移阳性率(25.0%vs.34.5%,P=0.556)、术后并发症发生率(25.0%vs.20.0%,P=0.666)、术后住院时间(10.9±3.5天vs.13.8±7.1天,P=0.125)差异均无统计学意义。侧方淋巴结转移与肿瘤低分化(P=0.001)、阳性脉管瘤栓(P=0.011)和神经侵犯(P=0.002)相关,但与术前是否行放化疗(P=0.479)及肿瘤大小(P=0.907)无关。结论腹腔镜直肠癌全系膜切除术基础上的侧方淋巴结清扫是安全可行的,并能达到和传统开放手术同样的围手术期临床效果。
[Abstract]:Objective to compare the perioperative results of lateral lymph node dissection in patients with middle and low rectal cancer on the basis of laparoscopic and open total mesorectal excision (TME), and to explore the feasibility and safety of laparoscopic pelvic lymph node dissection. Methods the clinical data of 16 patients with laparoscopy and 55 patients with open lateral lymph node dissection in Zhejiang Cancer Hospital were retrospectively analyzed. The perioperative time, blood loss and the number of lateral lymph nodes dissection were compared between the two groups. Postoperative complications and postoperative hospital stay. Results the basic clinical features of patients in laparoscopic group and open group were similar. There was no perioperative death in both groups. There was no conversion to open surgery in the laparoscopic group. The operative time of laparoscopic group was significantly longer than that of open group (218.6 卤71.6 min vs.181.3 卤57.9 min,P=0.035), and the amount of intraoperative bleeding was significantly decreased (190.6 卤80.1 ml vs.344.9 卤295.2 ml,P=0.044). The number of lateral lymph nodes dissected (9.8 卤6.1 vs.11.0 卤9.7, P0. 642) and the positive rate of lateral lymph node metastasis (25. 0vs.34. 5) in laparoscopic group and open group were 0. 556. The incidence of postoperative complications (25.0vs.20.0), postoperative hospitalization time (10.9 卤3.5days, vs.13.8 卤7.1days, P < 0.125) had no significant difference. Lateral lymph node metastasis was associated with low differentiation (P0. 001), positive vascular thrombus (P0. 011) and nerve invasion (P0. 002), but not with preoperative chemoradiotherapy (P0. 479) and tumor size (P0. 907). Conclusion Laparoscopic mesenterectomy based on lateral lymph node dissection is safe and feasible and can achieve the same perioperative effect as traditional open surgery.
【作者单位】：浙江省肿瘤医院结直肠外科;
【分类号】：R735.37

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