吲哚菁绿荧光腹腔镜侧方淋巴结清除术在中低位直肠癌中的临床疗效  

Clinical analysis of indocyanine green fluorescence laparo⁃scopic lateral lymph node dissection in middle and low rec⁃tal cancer

作　　者：杨阳 王信琛 张远耀 刘志伟 王思远 魏东 YANG Yang;WANG Xin-chen;ZHANG Yuan-yao;LIU Zhi-wei;WANG Si-yuan;WEI Dong(Department of Colorectal Surgery,the 989th Hospital of The Joint Logistics Support Force,Luoyang 471031,China)

机构地区：[1]联勤保障部队第九八九医院全军肛肠外科研究所结直肠外科,河南洛阳471031

出　　处：《中国现代普通外科进展》2024年第5期377-381,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨吲哚菁绿荧光腹腔镜侧方淋巴结清除术(LLND)在中低位直肠癌治疗中的应用价值。方法:回顾性分析2018年2月—2020年6月行手术治疗的76例中低位直肠癌患者的临床资料,行腹腔镜全直肠系膜切除术(TME)42例(TME组),行腹腔镜TME联合吲哚菁绿荧光LLND 34例(TME+LLND组),比较两组手术相关指标、围手术期恢复情况、肿瘤学指标及临床近期疗效。结果:TME+LLND组手术时间比TME组长(P<0.001)。与TME组比较,TME+LLND组淋巴结清除总数多(P<0.05);TME+LLND组有7例(20.59%)术后病理报告侧方淋巴结转移,髂外髂总血管区1例,闭孔区3例,髂内血管区3例。随访3年后,两组均未观察到肿瘤相关死亡;局部复发率TME+LLND组为2.94%,TME组为19.05%(P<0.05);远处转移率TME+LLND组为14.71%,TME组为9.52%(P>0.05)。结论:吲哚菁绿荧光腹腔镜直肠癌侧方淋巴结清除降低了局部复发率,且不增加术后并发症,在中低位直肠癌治疗中安全、有效、可行。Objective:To investigate the application value of indocyanine green fluorescence laparoscopic lateral lymph node dissection(LLND)in the treatment of middle and low rectal canMethods:Clinical data of 76 patients with middle and low rectal cancer who underwent surgical treatment from February 2018 to June 2020 were retrospectively analyzed,including 42 patients in the TME group who underwent laparoscopic total mesorectal resection and 34 patients in the TME+LLND group who underwent laparoscopic TME combined with indocyanine green fluorescence LLND.Results:The operation time of TME+LLND group was longer than that of TME group(P<0.001).Compared with TME group,the total number of lymph nodes dissected in TME+LLND group was higher(P<0.05).In the TME+LLND group,7 cases(20.59%)reported lateral lymph node metastasis.After 3 years of follow-up,the local recurrence rate was 2.94%in TME+LLND group and 19.05%in TME group(P<0.05).The distant metastasis rate was 14.71%in the TME+LLND group and 9.52%in the TME group(P>0.05).Conclusion:Indocyanine green fluorescence laparoscopic LLND can reduce the local recurrence rate and does not increase postoperative complications,so it is safe,effective and feasible in the treatment of middle and low rectal cancer.

关 键 词：直肠肿瘤 吲哚菁绿 荧光 侧方淋巴结 腹腔镜 

分 类 号：R735.37[医药卫生—肿瘤]