层面优先入路在腹腔镜低位直肠癌侧方淋巴结清扫术中的应用

Laparoscopic lateral lymph node dissection with priority to fascial space in treating patients with low rectal cancer

目的评估治疗性腹腔镜低位直肠癌层面优先入路侧方淋巴结清扫的技术可行性和安全性。方法回顾性分析2017年5月至2020年1月天津市人民医院连续收治的行治疗性腹腔镜低位直肠癌层面优先入路侧方淋巴结清扫的42例患者的临床资料,观察记录患者治疗效果及复发情况。结果 42例患者均顺利完成腹腔镜侧方淋巴结清扫术,无中转开腹病例,施行Miles手术17例、Dixon手术19例、Hartmann手术5例和1例联合前列腺切除的Miles手术,无术中及术后严重并发症及围手术期死亡患者。平均手术时间(426.18±116.12) min,中位术中出血量为200.00 (125.00,400.00) mL,单侧清扫28例、双侧清扫14例。中位术后住院时间14.00 (12.00,17.00) d,中位术后拔除尿管时间8.50 (7.00,11.00) d。发生围术期并发症3例,包括术后淋巴囊肿1例、术后下肢水肿1例、术后切口感染1例。术后病理示,TNM分期0期1例、Ⅰ期1例、Ⅱ期4例、Ⅲ期35例、Ⅳ期1例,肠系膜淋巴结中位转移数3.00 (0.00,5.00)枚、中位清扫数16.50 (13.00,19.00)枚,侧方淋巴结每侧中位转移数1.00 (0.00,2.00)枚、每侧中位清扫数7.50 (5.00,10.00)枚,侧方淋巴结阳性31例。中位随访9 (1~30)个月,未见侧方淋巴结复发病例。结论腹腔镜低位直肠癌层面优先入路侧方淋巴结清扫手术可以将侧方淋巴结清扫手术简单化、程序化,可以彻底清扫侧方淋巴结,并发症少,安全可靠。

Objectives To investigate the feasibility and safety of laparoscopic lateral lymph node dissection with priority to fas⁃cial space in treating patients with low rectal cancer.Methods This was a retrospective analysis of 42 consecutive patients with low rectal cancer who received laparoscopic lateral lymph node dissection with priority to fascial space between May 2017 and January 2020 at Tianjin Union Medical Center.Effectiveness and recurrence were recorded.Results All surgeries were com⁃pleted uneventfully in 42 patients.There were seventeen Miles operations,nineteen Dixon operations,five Hartmann operations and one combined Miles operation with prostatectomy.No intra-or serious postoperative complications or perioperative death was seen.The average duration of surgery was(426.18±116.12)min and the median intraoperative blood loss was 200.00(125.00,400.00)mL.There were 28 unilateral and 14 bilateral dissections.The median postoperative hospitalization was 14.00(12.00,17.00)days and the median time to Foley catheter removal was 8.50(7.00,11.00)days.There were three perioperative complica⁃tions,including one lymphocyst,one lower extremity edema,and one incision infection.Pathology showed 1 case of TNM stage 0,1 case of stageⅠ,4 cases of stageⅡ,and 35 case of stageⅢ,and 1 case of stageⅣ.The median number of mesenteric lymph node metastasis was 3.00(0.00,5.00)and yield was 16.50(13.00,19.00).The median number of unilateral lateral lymph node metastasis was 1.00(0.00,2.00)and yield was 7.50(5.00,10.00).31 patients had positive lateral lymph nodes.The median follow-up was 9(1~30)months and showed no recurrence in lateral lymph node.Conclusion Laparoscopic lateral lymph node dissection with priority to fascial space provided a safe,standardized,and friendly procedure in patients with low rectal cancer.It could completely remove the lateral lymph nodes and was associated with few complications.