直肠癌侧方淋巴结清扫的效果分析

The effective analysis on clearance of pararectal lymph nodes for carcinoma of rectum

目的 探讨下部直肠癌侧方淋巴结清扫与生存率和生存质量的关系。方法 对 780例腹膜返折处及其以下进展期直肠癌患者实施根治性切除术 ,其中腹腔内清扫 35 2例 ;腹腔内加腹膜外清扫 4 2 8例。二组在年龄、性别、Dukes′分期 ,病理组织学类型等方面差异无显著意义。结果 出现排尿功能损伤的患者 ,腹腔内清扫组为 12例 ,占 3 6 % ;腹腔内加腹膜外清扫组 2 2 5例 ,占 5 2 6 5 %(P <0 0 1)。性机能损伤 (仅统计男性 ) ,腹腔内清扫组 2 3例 ,占 12 6 % ( 2 3/183) ;腹腔内加腹膜外清扫组 12 7例 ,占 5 3 4 % ( 12 7/2 38) (P <0 0 1)。局部复发率腹腔内清扫组为 15 .9% ( 5 6 /35 2 ) ;腹腔内加腹膜外清扫组为 9 6 % ( 4 1/42 8) (P <0 0 5 )。 5年生存率腹腔内清扫组为 5 2 2 % ;腹腔内加腹膜外清扫组为 5 8 5 % (P <0 0 5 )。结论 二组患者相比 ,腹腔内加腹膜外清扫组虽然能减少局部复发和提高 5年生存率 。

Objective To consider the relationship to survival rate and quality of life with pararectal lymphadenectomy for lower carcinoma of rectum. Methods The radical operation was performed on 780 cases of progressive cancer located at peritoneal reflection or below it, Among them,352 cases only cleared in abdominal cavity, 428 cases coupled with extra peritoneal histopathological type. Results Urinary function injured, the group cleared in abdominal cavity was 12 cases, accounted for 3 6%; the group coupled with extra peritoneal clearance was 225 cases, for 52 5%( P <0 01). Sexual function damaged(only for male), the abdominal cavity group was 23 cases, for 12 6%(23/185); the coupled group was 127 cases, for 53 4%(127/238), ( P <0 01) Local relapse rate, the abdominal cavity group was 15 8%(56/352); the coupled group was 8 6%(41/428),( P <0 05). 5 year survival rate, the abdominal cavity group was 52 2%; the coupled group was 58 5% ( P <0 05). Conclusion By contrast ,although abdominal cavitr coupled with extraperitoneal lympadenectomy acted to cut down local relapse and to elevate 5 year survival rate, the postoperative quality of life appeared to be seriously affected.