中国实用外科杂志

中国实用外科杂志

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经血管外侧入路腹腔镜中低位直肠癌侧方淋巴结清扫72例临床分析

梁建伟，刘    骞，周思成，周海涛，裴    炜，姜    争，刘    正，郑朝旭，周志祥，王锡山   

  1. 国家癌症中心  国家肿瘤临床医学研究中心  中国医学科学院北京协和医学院肿瘤医院，北京 100021
  • 出版日期:2018-10-01 发布日期:2018-10-10

  • Online:2018-10-01 Published:2018-10-10

摘要：

目的    探讨血管外侧入路腹腔镜直肠癌侧方淋巴结清扫（LLND）的可行性和安全性。方法    回顾性分析2016年10月至2018年6月中国医学科学院肿瘤医院收治的行经血管外侧入路腹腔镜直肠癌LLND的72例病人的临床资料。术前同步放化疗38例，术前单纯化疗9例，25例术前未进行治疗，治疗前均经MRI或PET-CT检查诊断为侧方淋巴结转移。采用经髂外动脉远端入路行淋巴结清扫，高位结扎切断肠系膜下动脉并按全直肠系膜切除原则行直肠癌根治术，所有病人均完成清扫后再完成直肠切除，标本均达到整块切除。结果    19例病人行双侧LLND，28例行左侧LLND，25例行右侧LLND。平均侧方淋巴结检出数目为（8.3±6.2）枚；侧方淋巴结转移14例（19.4%），其中单侧转移12例，双侧转移2例。联合器官切除7例。手术时间为281.4（145~600）min，术中出血89.7（30~1200）mL。11例（15.3%）病人出现手术并发症，无手术死亡。术前同步放化疗病人侧方淋巴结阳性率为23.7%（9/38），术前单纯化疗病人侧方淋巴结阳性率为22.2%（2/9）。结论    血管外侧入路腹腔镜中低位直肠癌LLND不增加手术并发症，安全可行。

关键词: 直肠, 侧方淋巴结清扫, 腹腔镜, 手术入路

Abstract:

Lateral lymph node dissection via lateral vascular approach with en-bloc dissection of laparoscopic total mesorectal excision for advanced middle and low rectal cancer        LIANG Jian-wei, LIU Qian, ZHOU Si-cheng, et al. National Cancer Center & National Clinical Research Center for Cancer & Cancer Hospital，Chinese Academy of Medical Sciences and Peking Union Medical College，Beijing 100021，China
Corresponding authors: LIU Qian，E-mail: fcwpumch@163.com；WANG Xi-shan，E-mail: wxshan1208@126.com
Abstract    Objective    To investigate the feasibility and safety of the en-bloc resection via lateral vascular approach combined with lateral lymph node dissection (LLND). Methods    The clinical and pathological data of 72 cases of laparoscopic total mesorectal excision resection of rectal cancer combined with LLND via lateral vascular approach were retrospectively analyzed. There were 38 cases of preoperative chemoradiotherapy，9 patients with neochemotherapy，25 cases without preoperative treatment. All patients were diagnosed with lateral lymph node metastasis by MRI or PET-CT before treatment. The first step of LLND was performed by the distal of external iliac artery，then high ligation the inferior mesenteric vascular and opened the left Toldt’ space，and the final step was the total mesorectal excision. All of the spacemen were en-bloc dissection of the later lymph node with the rectal cancer. Results    There were 19 cases of bilateral LLND，28 cases with unilateral left LLND，25 cases on the right side. The harvested pelvic lymph node detection was 8.3，19.4% of lateral lymph node metastasis rate（14/72），12 cases of unilateral lateral lymph node metastasis，2 cases of bilateral metastasis，and 7 patients combined viscera resection（9.7%）. The operative time was 281.4（145~600）min and the intraoperative blood loss was 89.7（30~1200）mL. A total of 11 cases（15.3%）had surgical complications and no surgical death. The positive rate of lateral pelvic lymph node in preoperative chemoradiotherapy patients was 23.7% （9/38），and 22.2%（2/9）in the neochemotherapy group. Conclusion    Laparoscopic resection of rectal cancer combined with LLND via transvascular lateral approach is safe and feasible，and not increase in operative complications.

Key words: rectal cancer, lateral pelvic lymph node dissection, laparoscopy, surgical approach