中低位直肠癌TME手术结合侧方淋巴结清扫的临床意义研究

目的研究中低位直肠癌行全直肠系膜切除术(TME)结合侧方淋巴结清扫(LLND)的临床意义。方法回顾性分析2013年1月至2014年12月73例中低位直肠癌患者资料,根据不同术式将其分为联合组及TME组两组。TME组患者34例,联合组患者39例,行TME+LLND。临床数据分析使用统计学软件SPSS 24.0,围术期指标等计量资料采用(x±s)表示,独立样本t检验;术后并发症等计数资料采用χ^2检验;用K-M法绘制生存曲线,并采用Log-rank检验分析生存率差异。P<0.05为检验标准。结果TME组手术时间及手术出血量均较联合组少(P<0.05);两组术后排气时间、术后住院时间、并发症发生率、性功能障碍、排尿障碍及术后1年、3年的局部复发率比较,差异均无统计学意义(P>0.05);联合组术后5年的局部复发率为7.7%,低于TME组的26.5%,(P<0.05);TME组术后1、3、5年生存率分别为82.4%、61.8%、52.9%;联合组术后1、3、5年生存率分别为92.3%、82.1%、74.4%,联合组术后生存率优于TME组,差异有统计学意义(P<0.05)。结论中低位直肠癌行TME+LLND术可提高患者的远期生存率,且在手术技巧和精细操作下,保证患者术后生活质量,有积极的临床意义。

Clinical significance of Total Mesorectal Excision combined with lateral lymph node dissection for middle/low rectal cancer

Objective To investigate the clinical significance of Total Mesorectal Excision(TME)combined with lateral lymph node dissection for middle/low rectal cancer.Methods From January 2013 to December 2014,retrospective analysis of clinical data was performed in 73 patients with middle/low rectal cancer.According to different surgical methods,73 patients were divided into the combined group(39 cases)and the TME group(34 cases).Statistical analysis of clinical data were performed by using SPSS 24.0 software.Measurement data such as perioperative indicators were expressed as (x±s) and examined by using independent sample t-test.Count data such as postoperative complications were examined by usingχ^2 test.The survival was analyzed by using K-M method and log-rank test.A P value of<0.05 was considered as significant difference.Results The operation time and intraoperative bleeding volume in the TME group were less than those in the combined group respectively,with significant difference(P<0.05).There was no significant difference between two groups in terms of the postoperative exhaust time,postoperative hospitalization,the incidence of complications,incidence of sexual dysfunction or dysuria and local recurrence rate of 1 and 3 years after operation(P>0.05).The 5-year local recurrence rate of the combined group was 7.7%,which was lower than 26.5%in the TME group(P<0.05);The 1-year,3-year and 5-year survival of TME group were 82.4%,61.8%and 52.9%,while the 1-year,3-year and 5-year survival of combined group were 92.3%,82.1%and 74.4%respectively,and better survival were achieved in combined group with significant difference(P<0.05).Conclusion TME+LLND surgery could improve the long-term survival of patients with middle/low rectal cancer,and it has positive clinical significance to ensure the quality of life of patients after operation with refined skills and operation.