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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 investigate the effect of root canal ligation and regional lymphadenectomy on the survival rate of advanced mesenteric artery (IMA) in advanced rectal cancer. METHODS: Sixty-nine patients with D3 lymphadenectomy underwent ligation of the inferior mesenteric artery and 56 patients with rectal cancer underwent non-root radical ligation at the same time. Results: The metastatic rate of lymph nodes around the roots and abdominal aorta of the inferior mesenteric artery was 11.6%. The tumor invasion depth was significantly increased in the pT3 and pT4 phases. The 5-year survival rate was 37.5 % in patients with root metastasis of the inferior mesenteric artery and 70.5 % in patients without root lymph node metastasis. In addition, the overall 5-year survival rate of D3 lymph node dissection in the inferior mesenteric artery was 66.7 %. Significantly higher than non-rooted ligation radical mastectomy (48.2%). CONCLUSIONS: For radical resection of the rectal cancer, emphasis is placed on the ligation of the inferior mesenteric artery and the removal of the lymph nodes around the aorta, and the addition of lateral and total mesorectal excision to the lower rectal cancer, especially in patients with pT3 and pT4, can improve the patient. 5-year survival rate.