两种方式治疗直肠癌疗效及对患者生存期的影响

Effects of low ligation of inferior mesenteric artery combined with D3 lymph node dissection and high ligation in the treatment of rectal cancer and the influence on survival time:a comparative study

目的分析肠系膜下动脉(IMA)低位结扎伴D3淋巴结清扫术与高位结扎治疗直肠癌疗效及对患者生存期的影响。方法回顾性分析于我院进行手术治疗的95例直肠癌患者临床资料,根据其手术方式将患者分为低位结扎组和高位结扎组,前者行IMA低位结扎伴D3淋巴结清扫术,后者行高位结扎。对比两组手术及术后机体恢复情况、淋巴结清扫结果、术后并发症及生存情况。结果低位结扎组手术时间长于高位结扎组(P<0.05),术后通气时间短于高位结扎组(P<0.05),术中出血量、住院时间与高位结扎组比较差异无统计学意义(P>0.05);低位结扎组D3淋巴结清扫数目、淋巴结清扫总数目与高位结扎组比较差异均不显著(P>0.05);低位结扎组吻合口瘘发生率低于高位结扎组(P<0.05),其他并发症发生率与高位结扎组比较差异均不显著(P>0.05);两组肿瘤复发率及术后3年累积生存率比较差异不显著(P>0.05)。结论IMA低位结扎伴D3淋巴结清扫术与高位结扎治疗直肠癌的疗效及术后3年累积生存率相近,但IMA低位结扎伴D3淋巴结清扫术更能够减少吻合口瘘发生。

Objective To analyze the effects of low ligation of inferior mesenteric artery(IMA)combined with D3 lymph node dissection and high ligation in the treatment of rectal cancer and the influence on survival time.Methods The clinical data of 95 rectal cancer patients receiving surgical treatment were retrospectively analyzed.According to the surgical method,they were divided into low ligation group and high ligation group.The former received low ligation of IMA combined with D3 lymph node dissection,while the latter received high ligation.The surgery,postoperative body recovery,outcomes of lymph node dissection,postoperative complications and survival were compared between the two groups.Results The operation time of low ligation group was longer than that of high ligation group(P<0.05),and postoperative ventilation time was shorter than that of high ligation group(P<0.05).There were no significant differences in intraoperative blood loss,hospital stay,the number of lymph nodes removed by D3 lymph node dissection and the total number of lymph node removed between the two groups(P>0.05).The incidence of anastomotic leakage in low ligation group was lower than that in high ligation group(P<0.05),but there was no significant difference in the incidence of other complications between the two groups(P>0.05).There were no significant differences in tumor recurrence rate and postoperative 3-year cumulative survival rate between the two groups(P>0.05).Conclusion Low ligation of IMA combined with D3 lymph node dissection can achieve similar effects and postoperative 3-year cumulative survival rate in the treatment of rectal cancer.However,the former can better reduce the occurrence of anastomotic leakage.