筋膜导向的腹腔镜侧方淋巴结清扫在进展期低位直肠癌根治术中的临床价值  

Clinical value of fascia orientated laparoscopic lateral lymph node dissection in radical excision for advanced low rectal cancer

作　　者：刘涛[1] 汤坚强 李华玉 张峻岭[1] 汪欣[1] Liu Tao;Tang Jianqiang;Li Huayu;Zhang Junling;Wang Xin(Department of General Surgery,Peking University First Hospital,Beijing 100034,China;Department of Colorectal Surgery,Cancer Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100192,China)

机构地区：[1]北京大学第一医院普通外科,北京100034 [2]中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100192

出　　处：《中华消化外科杂志》2022年第6期809-815,共7页Chinese Journal of Digestive Surgery

基　　金：国家重大疾病多学科诊疗能力建设项目。

摘　　要：目的探讨筋膜导向的腹腔镜侧方淋巴结清扫(LLND)在进展期低位直肠癌根治术中的临床价值。方法采用回顾性描述性研究方法。收集2013年1月至2021年8月北京大学第一医院收治的100例进展期低位直肠癌患者的临床病理资料;男69例,女31例;年龄为58(32~85)岁。患者均行腹腔镜直肠癌全系膜切除术,以筋膜为导向行LLND。观察指标:(1)手术情况。(2)术后情况。(3)组织病理学检查结果。(4)随访情况。采用电话、门诊、病案复查等方式进行随访,了解患者生存、疾病进展、肿瘤复发和转移情况。生存时间为手术日期至死亡时间或末次随访时间。随访时间截至2021年8月。计量资料以M(范围)表示。计数资料以绝对数或百分比表示。采用Kaplan-Meier法绘制生存曲线并计算生存率。结果(1)手术情况:100例患者中,44例行新辅助治疗,56例未行术前治疗。100例患者均行腹腔镜进展期低位直肠癌根治术,其中直肠癌低位前切除术60例(单侧LLND 49例、双侧LLND 11例),直肠癌腹会阴联合切除术20例(单侧LLND 16例、双侧LLND 4例),全盆腔脏器联合切除术12例(单侧和双侧LLND各6例),Hartmann术5例(单侧LLND 3例、双侧LLND 2例),后盆腔脏器联合切除术3例(单侧LLND 2例、双侧LLND 1例)。患者手术时间为258(200~325)min,术中出血量为100(50~200)mL。19例行直肠癌低位前切除术患者同时行回肠保护性造瘘术。3例患者术中因淋巴结侵犯闭孔神经致剥离时损伤(未离断)。100例患者中,12例(行全盆腔脏器切除术患者)切除输尿管腹下神经筋膜,88例保持输尿管腹下神经筋膜完整。(2)术后情况:100例患者均无围手术期死亡,术后拔除尿管时间为4(3~7)d,住院时间为11(9~15)d。26例患者发生术后并发症。(3)组织病理学检查结果:100例患者术后病理学检查结果显示肿瘤最大径为4.5(3.8~5.9)cm;肿瘤大体分型肿块型21例、溃疡型79例;肿瘤分化程度为�Objective To investigate the clinical value of fascia orientated laparoscopic lateral lymph node dissection(LLND)in radical excision for advanced low rectal cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 100 patients with advanced low rectal cancer who were admitted to Peking University First Hospital from January 2013 to August 2021 were collected.There were 69 males and 31 females,aged 58(range,32-85)years.Patients underwent laparoscopic total mesorectal excision and fascia oriented LLND.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)results of histopathological exa-mination;(4)follow-up.Follow-up was conducted by telephone interview,outpatient examination and medical records review to detect survival,disease progression,tumor recurrence and metastasis of patients up to August 2021.Survival time was from the surgery date to death or the last follow-up time of patients.Measurement data were represented as M(range).Count data were represented as absolute numbers.Kaplan-Meier method was used to draw survival curves and calculate survival rates.Results(1)Surgical situations.Of the 100 patients,44 cases underwent neoadjuvant therapy and 56 cases didn′t receive preoperative therapy.Of the 100 patients with laparoscopic radical excision for advanced low rectal cancer,60 cases underwent low anterior resection of rectal cancer including 49 cases with unilateral LLND and 11 cases with bilateral LLND,20 cases underwent abdomin-operineal resection for rectal cancer including 16 cases with unilateral LLND and 4 cases with bilateral LLND,12 cases underwent total pelvic exenteration including 6 cases with unilateral LLND and 6 cases with bilateral LLND,5 cases underwent Hartmann surgery including 3 cases with unilateral LLND and 2 cases with bilateral LLND,3 cases underwent posterior pelvic exenteration including 2 cases with unilateral LLND and 1 case with bilateral LLND.The operation time and volume of intraoperative blood loss were 258(ra

关 键 词：直肠肿瘤 筋膜导向 侧方淋巴结清扫术 腹腔镜检查 预后 

分 类 号：R735.37[医药卫生—肿瘤]