低位直肠癌不同切除范围的疗效分析

Analysis of the Effective of Different Clearance Scope for Lower Rectal Cancer

目的:探讨低位直肠癌全直肠系膜切除与侧方淋巴结清扫对局部复发率、生存率和术后生存质量的影响。方法:对426例低位直肠癌行根治性切除,其中241例行全直肠系膜切除,185例全直肠系膜切除+侧方淋巴结清扫。结果:无手术死亡病例,两组在性别、年龄、肿瘤肠壁的浸润深度、组织学类型等方面差异无显著意义。全直肠系膜切除组排尿功能障碍占5.8%,性功能障碍占13.2%;而侧方淋巴结清扫组分别是51.9%和51.9%(P<0.05)。局部复发率,全直肠系膜切除组DukesC期为23.5%,而侧方淋巴结清扫组为12.0%(P<0.05),5年生存率两组差异无显著性(P>0.05)。结论:低位直肠癌行侧方淋巴结清扫能降低术后局部复发率,但对术后生存质量有影响。

Objective： To study the relationship of local relapse rate , survival rate and quality of life with total mesoreetal excision and lateral lymphadenectomy for lower rectal cancer. Methods： The radical operation were performed on 426 eases of lower rectal cancer. Among them ,241 eases was performed total mesoreetal excision and 185 eases coupled with lateral lymphadenectomy. Results： There were no death eases in both groups. Urinary function injury,in total mesoreetal excision group accounted for 5.8%, 51.9% （ P 〈 0.01 ） in lateral lymphadeneetomy group. Sexual function damange （ only for male） in total mesoreetal excision group accounted for 13.2% ,51.9% （P 〈 0.01 ） in lateral lymphadenectomy group accounted for 51.9% （ P 〈 0.01 ） Local relapse rate in total mesorectal excision group for Dukes B and C cases was 17%, in lateral lymphadenectomy group was 10.3% （ P 〈 0.05）. The 5-year survival rate of the two groups did not have statistical significant difference （P 〉 0.05）. Conclusion： The lateral lymphadenectomy in lower rectal cancer can decrease local relapse, but the postoperative quality of life was affected.