肠系膜下动脉根部结扎及淋巴廓清对直肠癌根治术的临床评价

Clinical Significance of High Ligation of Inferior Mesenteric Artery andExtensive Lymphadenectomy in Adavanced Rectal Cancer

目的 :研究进展期直肠癌肠系膜下动脉(IMA)根部结扎和区域性淋巴廓清对患者生存率的影响。方法 :分析行肠系膜下动脉根部结扎的D3 式淋巴廓清术69例和同期行非根部结扎根治术直肠癌56例。结果 :肠系膜下动脉根部及腹主动脉周围淋巴结转移率为11.6 % ,肿瘤浸润深度 pT3 和 pT4 期发生转移明显增多。有肠系膜下动脉根部淋巴结转移者5年生存率为37.5 % ,而无根部淋巴转移者为70.5 % ;同时 ,行肠系膜下动脉根部结扎的D3 式淋巴廓清术总的5年生存率为66.7 % ,明显高于非根部结扎的根治术者(48.2 %)。结论 :对直肠癌根治术 ,强调行肠系膜下动脉根部结扎和近腹主动脉周围淋巴结清扫 ,对下部直肠癌加行侧方及全直肠系膜切除术 ,尤其对pT3 和pT4 期患者 ,能提高患者5年生存率。

Objective: To evaluate the curative effect of high ligation of inferior mesenteric artery and extensive lymphadenectoy after resection of advanced rectal cancer and its affection on survival rate. Methods: Sixty-nine consecutive patients with advanced rectal cancer undergone high ligation of IMA with D3 extensive lymphadenectomy and 56 patients with low level ligation and conventional curative resection were analysed retrospectively. Results: The metastatic rate of the lymph nodes at the root of inferior mesenteric artery or around abdominal aorta was 11.6%. IMA root nodal metastases occurred more frequently in pT3 and pT4 stage cancers. The 5-year survival rate in the patients with IMA root nodal metastases was 37.5%; this rate was significantly lower than in those without IMA root metastasis (70.5%). Similarly the 5-year survival rate in patients who underwent high ligation of IMA with D3 wide lymphadenectomy was 66.7%; this rate was significantly higher than in those without ligation of IMA (48.2%). Conclusion: In curative resection of advanced rectal cancer, high ligation of IMA and extensive regional lymph node resection are recommended for patients with pT3 and pT4 stage rectal cancer and it would increase the 5-year survival rate.