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目的探讨选择性侧方淋巴结清扫在腹腔镜低位进展期直肠癌全直肠系膜切除术(TME)中的应用价值。方法回顾性分析2014年1月到2016年1月漯河市中心医院收治的40例腹腔镜直肠癌TME患者的临床资料,其中腹腔镜TME侧方淋巴结清扫组(LLND组)18例,腹腔镜TME组(TME组)22例。比较两组手术时间、术中出血量、清扫淋巴结数、侧方淋巴结阳性例数、术后尿管留置时间、尿潴留、盆腔感染、吻合口漏及输尿管损伤等并发症情况。结果两组均腹腔镜辅助完成,LLND组及TME组的手术时间分别为(215.6±14.3)min和(198.7±7.1)min,术中出血量分别为(86.1±13.6)ml和(74.5±14.5)ml,清扫淋巴结数分别为(16.2±3.6)枚和(14.0±2.7)枚,两组比较差异均有统计学意义(P均<0.05)。LLND组和TME组术后留置尿管时间分别为(7.0±1.1)d和(6.8±1.0)d;术后并发症:尿潴留分别为3例和2例、吻合口漏分别为1例和2例、盆腔感染分别为2例和3例,两组并发症发生率比较差异均无统计学意义(P均>0.05);两组均无尿管损伤。术后门诊复查随访或电话随访,LLND组和TME组获得1年随访时间者分别为16例和22例,术后肿瘤局部复发2例,均来自TME组。结论低位进展期腹腔镜直肠癌选择性LLND未增加围手术期并发症,有益于控制局部复发率。
Objective To investigate the value of selective lateral lymph node dissection in laparoscopic low-grade total mesorectal excision of rectal cancer (TME). Methods The clinical data of 40 cases of TME patients with laparoscopic rectal cancer treated in Luohe Central Hospital from January 2014 to January 2016 were retrospectively analyzed. Among them, 18 patients underwent laparoscopic TME lateral lymph node dissection (LLND group), laparoscopic TME Group (TME group) 22 cases. The complications such as operative time, intraoperative blood loss, number of lymph nodes dissected, number of lateral lymph nodes, postoperative catheter indwelling time, urinary retention, pelvic infection, anastomotic leakage and ureteral injury were compared. Results The two groups were assisted by laparoscopy. The operative time of LLND group and TME group were (215.6 ± 14.3) min and (198.7 ± 7.1) min respectively, and the intraoperative blood loss were (86.1 ± 13.6) ml and (74.5 ± 14.5) ) ml, and the number of lymph nodes dissected was (16.2 ± 3.6) mm and (14.0 ± 2.7) mm respectively. There were significant differences between the two groups (all P <0.05). The postoperative indwelling catheter time in LLND group and TME group were (7.0 ± 1.1) days and (6.8 ± 1.0) days, respectively. Postoperative complications were urinary retention in 3 and 2 cases, anastomotic leakage in 1 case and 2 cases and pelvic infection were 2 cases and 3 cases respectively. There was no significant difference in the complication rates between the two groups (P> 0.05). There was no catheter injury in both groups. Postoperative follow-up visits or telephone follow-up, LLND group and TME group obtained one-year follow-up were 16 cases and 22 cases, 2 cases of local tumor recurrence after surgery, all from the TME group. Conclusions The selective LLND of low-grade advanced laparoscopic rectal cancer does not increase the perioperative complications, which is beneficial to control the local recurrence rate.