摘要
目的研究直肠癌肠系膜下动脉（inferior mesenteric anery，IMA）根部淋巴结的转移规律，探讨IMA根部淋巴结清扫在直肠癌根治术中的意义。方法回顾性分析北京大学第一医院2005--2008年间接受直肠癌手术并进行IMA根部淋巴结清扫的105例直肠癌患者的临床病理资料，对IMA根部淋巴结转移的影响因素进行单因素及多因素分析，并与同期收治的未行IMA根部淋巴结清扫的204例直肠癌患者的术后5年生存率及局部复发率进行比较。结果IMA根部淋巴结转移率为9．5％（10／105），淋巴结有转移患者的5年生存率（20．0％，2／10）明显低于无转移者（76．9％，70／91）（x^2=21．546，P〈0．05）。多因素分析显示肿瘤浸润深度（Wald=5．764，P〈0．05）为pT3、pT4，分化程度为低分化、未分化的直肠癌患者（Wald=7．818，P〈0．05），IMA根部淋巴结转移率明显增高。IMA根部淋巴结清扫与否的5年生存率分别为71．3％（72／101）和70．6％（142／201），差异无统计学意义（X^2=0．000，P=0．995）；局部复发率分别为1．9％（2／105）和7．4％（15／204），差异有统计学意义（X^2=3．958，P〈0．05）。结论肠系膜下动脉根部淋巴结清扫并不能提高直肠癌患者的5年生存率，但是可以降低局部复发率；对于肿瘤浸润深度为T3、T4，分化程度为低分化、未分化的直肠癌，肠系膜下动脉根部淋巴结清扫降低了局部复发率。
Objective To investigate factors affecting the metastasis of lymph nodes around the rootof inferior mesenteric artery（IMA） in rectal cancer, and the significance of root lymph nodes dissection of IMA in radical surgery for rectal cancer. Methods Clinicopathological data of 105 rectal cancer patients undergoing root lymph node dissection of IMA during radical resection in Peking University First Hospital from January 2005 to December 2008 were analyzed retrospectively. Rectal cancer patients without root lymph node dissection of IMA during the same period served as control. Results were compared between these two groups for survival and local recurrence rates. Results The rate of lymph node metastasis around the origin of IMA was 9. 5% （ 10/105 ）. The five-year survival rate in patients with IMA root nodal dissection was 71.3%, and that without was 70. 6% （P =0. 995） ,while the local recurrence was respectively 1.9% and 7.4% （ P 〈 0.05 ）. In multivariate analyses, IMA root nodal metastasis occurred more frequently in patients with pT3 and pT4 tumor （ Wald = 5. 764, P 〈 0. 05 ） and poorly differentiated tumor （ Wald = 7.818, P 〈 0. 05）. Conclusions Root lymph nodes dissection of IMA could not increase five-year survival rate, but it could reduce local recurrence rate in patients with rectal cancer. In radical surgery of rectal cancer, lymphadenectomy of IMA root should be performed in patients with 33 and T4 tumor with poorly differentiated tumor, so as to reduce local recurrence rate.
出处
《中华普通外科杂志》
CSCD
北大核心
2013年第8期586-589,共4页
Chinese Journal of General Surgery
