摘要
目的 探讨腹腔镜直肠癌低位前切除术中，保留左结肠动脉（LCA）和廓清肠系膜下动脉根部淋巴结（IMA）的长期疗效。方法 2007年1月至2011年12月期间，共有322例患者在首都医科大学附属北京朝阳医院普通外科行腹腔镜直肠癌低位前切除术，其中168例术中保留LCA并廓清IMA根部淋巴结（保留LCA组）；154例不保留LCA，于IMA根部结扎切断血管（不保留LCA组）。比较两组患者的长期预后情况。结果 两组患者基线资料的比较，差异均无统计学意义（均P 〉 0.05）。保留LCA组随访5~60月，随访率91.1%（153/168），期间死亡49例（32.0%），9例（5.9%）出现局部复发，62例（40.5%）出现转移。不保留LCA组随访6~60月，随访率90.3%（139/154），期间死亡44例（31.7%），9例（6.5%）出现局部复发，52例（37.4%）出现转移。两组病死率、局部复发率及转移率的比较，差异均无统计学意义（均P 〉 0.05）。保留LCA组和不保留LCA组术后5年无病生存率分别为57.2%和59.7%，两组比较，差异无统计学意义（P 〉 0.05）。按病理分期分层后，保留LCA组Ⅰ、Ⅱ、Ⅲ期患者术后5年无病生存率分别为80.4%、62.5%和45.1%，不保留LCA组为82.6%、66.0%和48.8%，两组比较，差异也无统计学意义（P 〉 0.05）。保留LCA组和不保留LCA组术后5年总体生存率分别为69.5%和70.1%，两组比较，差异仍无统计学意义（P 〉 0.05）。按病理分期分层后，保留LCA组Ⅰ、Ⅱ、Ⅲ期患者术后5年总体生存率分别为90.2%、76.2%和56.7%，不保留LCA组为94.4%、74.3%和60.5%，两组比较，差异同样无统计学意义（P 〉 0.05）。结论 腹腔镜直肠癌低位前切除术中，保留LCA、廓清IMA根部淋巴结的远期疗效与于IMA根部结扎切断血管相当。
Objective To investigate the long-term outcomes of laparoscopic low anterior resection of rectal carcinoma with preservation of the left colic artery （LCA） .Methods Clinicopathological and follow-up data of 322 cases with rectal carcinoma undergoing laparoscopic low anterior resection in Department of General Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2007 to December 2011 were retrospectively analyzed. According to the different surgical methods of inferior mesenteric artery （IMA） , cases were divided into the trial group （LCA preservation plus lymph nodes around IMA root dissection, 168 cases） and the control group （origin of IMA ligation, 154 cases） . The 5-year rates of disease-free survival （DFS） and overall survival （OS） were compared between two groups.Results There were no statistically significant differences in the baseline data between the two groups. The follow-up rate was 91.1% （153/168） during 5-60 months in the trial group, and 90.3% （139/154） during 6-60 months in the control group. The number of patients who developed death, local recurrence and metastasis were 49 （32.0%） , 9 （5.9%） and 62 （40.5%） in the trial group, and 44 （31.7%） , 9 （6.5%） and 52 （37.4%） in the control group, respectively, without significant differences （all P 〉 0.05） . The 5-year DFS and OS rates were 57.2% and 69.5% in the trial group, and 59.7% and 70.1% in the control group, and the differences were not significant between the two groups （all P 〉 0.05） . After stratification by TNM stage, the 5-year DFS rates of Ⅰstage, Ⅱ stage and Ⅲ stage were 80.4%, 62.5% and 45.1% in the trial group, and 82.6%, 66.0% and 48.8% in the control group; the 5-year OS rates of Ⅰ stage, Ⅱ stage and Ⅲ stage were 90.2%, 76.2% and 56.7% in the trial group, and 94.4%, 74.3% and 60.5% in the control group, respectively, and the differences were not significant as well （all P 〉 0.05） .Conclusion The long-term outcomes after laparoscopic low anterior resection of rectal carcinoma with preservation of LCA and dissection of lymph nodes around root of IMA are comparable with ligation at origin of IMA.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第6期660-664,共5页
Chinese Journal of Gastrointestinal Surgery
关键词
直肠肿瘤
左结肠动脉
肠系膜下动脉
远期疗效
Rectal neoplasms
Left colic artery
Inferior mesenteric artery
Long-term outcomes
