扩大淋巴结清扫范围对低位直肠癌预后的影响

Impact of expanding the scope of lymph node for prognosis in lower rectal cancer

目的:探讨扩大淋巴结清扫范围对低位直肠癌术后恢复、局部复发率、生存率和生存质量的影响。方法:回顾性分析我院327例低位直肠癌行根治性切除的病例资料,其中171例行全直肠系膜切除(TME),156例全直肠系膜切除+C区(侧方)淋巴结清扫(TME+C)。结果:无手术死亡病例,两组在性别、年龄、肿瘤临床分期、组织学类型等方面差异无显著意义。TME组围手术期住院时间为(10.9±1.8)天,低于TME+C组(14.0±2.0)天;住院费用TEM组为(1.52±0.11)万元,低于TME+C组(2.01±0.15)万元(P<0.05);两组在总体局部复发率上无统计学差异,但Dukes B、Dukes C期TME+C组局部复发率明显下降,两组差异有显著性(P<0.05);总体5年生存率TME组为53.2%,而TME+C组为57.1%,两组无显著差异(P>0.05),亚组分析显示Dukes B期TME+C组5年生存率高于TME组(P<0.05);两组在生活质量方面无差异(P>0.05)。结论:Dukes A和Dukes C期低位直肠癌行根治术且TME+C术增加患者手术创伤,住院时间延长,但不提高5年生存率;Dukes B期直肠癌行根治术且TME+C术虽然延长住院时间,但可改善患者5年生存率。

Objective：To investigate local recurrence rate,survival rate and quality of life impact of the expansion of the scope of lymph node on the postoperative recovery of low rectal cancer.Methods：Retrospective analysis of 327 cases in our hospital for lower rectal cancer cases radical resection,of which were 171 routine total mesorectal excision（TME）,156 cases of mesorectal excision C area lymph node dissection（TME ＋ C）.Results：There was no operative deaths,both in terms of gender,age,tumor clinical stage,histolgical type, etc. There was no significant difference. TME group perioperative time was 10. 9± 1.8 days, lower than the TME ＋ C group（ 14. 0 ±2. 0 days） ; hospitalization costs 15 200 ±1 100 yuan, lower than the TME ＋ C group 20 100 ± 1 500 yuan （ P 〈 0. 05 ） ; the two groups in the overall local recurrence rate was no significant difference, but the difference was Dukes＇B, C period of TME ＋ C group significantly decreased local recurrence rate（P 〈0. 05）. The overall 5-year survival rate TME group was 53.2%, while the TME ＋ C group was 57. 1% （ P 〉 0. 05 ）. Subgroup analysis showed that in Dukes＇B 5-year survival rate of TME ＋ C group was higher than that of the TME group （ P 〈 0. 05 ） ; the two groups in quality of life without differences （ P 〉 0. 05 ）. Conclusion ： Expansion the scope of lymph node in early and lateral stage of low rectal cancer increase surgical trauma, hospitalization time, but does not improve 5-year survival rate. Although length of stay, TME plus extended lymph node on advanced low rectal cancer can be improved 5-year survival rate in patients.