以筋膜导向解剖入路的直肠癌侧方淋巴结清扫在男性直肠癌患者全直肠系膜切除术中的疗效

Curative effect of lateral lymph node dissection through fascia-oriented anatomical approach in male patients with rectal cancer during total mesorectal excision

目的探讨全直肠系膜切除术(TME)术中应用以筋膜导向解剖入路的直肠癌侧方淋巴结清扫术(LLND)在男性直肠癌患者中的治疗效果。方法选取2017年1月至2020年6月在中国人民解放军南部战区总医院就诊的男性直肠癌患者80例,采用意向性治疗分析方法,根据患者意向分配接受TME术中应用血管导向解剖入路的LLND治疗的患者38例为对照组,接受TME术中应用以筋膜导向解剖入路的LLND治疗的患者42例为观察组。比较两组患者手术相关指标、术后恢复情况、术后功能异常、术后并发症。出院后定期进行随访,采用结直肠癌生活质量专用量表(EORTC QLQ-CR38)评价患者术前及术后1、3、6个月的生活质量,统计术后无进展生存率。结果观察组与对照组手术时间、术中出血量无统计学差异(P>0.05),清扫淋巴结数量多于对照组(P<0.05)。两组术后首次通气时间、首次下床活动时间、住院时间均无统计学差异(P>0.05);术后并发症(腹腔感染、吻合口瘘、尿潴留、尿管损伤、切口感染)发生率无统计学差异(P>0.05);术后排尿功能及性功能异常发生率无统计学差异(P>0.05)。术后3个月和6个月观察组患者EORTC QLQ-CR38评分高于对照组(P<0.05);观察组术后无进展生存率高于对照组(P<0.05)。结论TME术中应用以筋膜导向解剖入路的直肠癌LLND在男性直肠癌患者中效果显著,可提高淋巴结清扫数量,延长患者术后生存期。

Objective To explore the curative effect of lateral lymph node dissection(LLND)through fascia-oriented anatomical approach in male patients with rectal cancer during total mesorectal excision(TME).Methods A total of 80 male patients with rectal cancer treated in General Hospital of The PLA Southern Theater Command were enrolled between January 2017 and June 2020.According to different intentions,they were divided into control group(38 cases,LLND through vessel-oriented anatomical approach)and observation group(42 cases,LLND through fascia-oriented anatomical approach).The surgical related indexes,postoperative recovery,postoperative function abnormalities and postoperative complications were compared between the two groups.All underwent regular follow-up after discharge.Before surgery,at 1 month,3 months and 6 months after surgery,quality of life was evaluated by the Europe Organization for Research and Treatment of Cancer quality of life questionaire-colorectal 38(EORTC QLQ-CR38).The postoperative progression-free survival rates in both groups were analyzed.Results There was no significant difference in operation time or intraoperative blood loss between the two groups(P>0.05).The number of dissected lymph nodes in observation group was more than that in control group(P<0.05).There was no significant difference in first ventilation time,leaving bed time or hospitalization time between the two groups(P>0.05).There was no significant difference in the incidence of postoperative complications(abdominal infection,anastomotic fistula,urinary retention,urinary duct injury,incision infection)between the two groups(P>0.05).There was no significant difference in the incidence of urinary dysfunction and sexual dysfunction between the two groups(P>0.05).At 3 and 6 months after surgery,EORTC QLQ-CR38 scores in observation group were higher than those in control group(P<0.05),and postoperative progression-free survival rate was slightly higher than that in control group(P<0.05).Conclusion The application effect of LLND through fascia-oriented anatomical approach is significant for male patients with rectal cancer during TME,which can increase number of dissected lymph nodes and prolong postoperative survival.