• 医学文献
  • 知识库
  • 评价分析
  • 全部
  • 中外期刊
  • 学位
  • 会议
  • 专利
  • 成果
  • 标准
  • 法规
  • 临床诊疗知识库
  • 中医药知识库
  • 机构
  • 作者
热搜词:
换一批
论文 期刊
取消
高级检索

检索历史 清除

医学文献 >>
  • 全部
  • 中外期刊
  • 学位
  • 会议
  • 专利
  • 成果
  • 标准
  • 法规
知识库 >>
  • 临床诊疗知识库
  • 中医药知识库
评价分析 >>
  • 机构
  • 作者
热搜词:
换一批

经肛入路侧方淋巴结清扫手术治疗中低位直肠癌五例

Transanal lateral lymph node dissection surgery for 5 cases of mid?low rectal cancer

摘要:

目的 初步探讨经肛入路侧方淋巴结清扫手术治疗中低位直肠癌的可行性及安全性.方法 采用描述性病例系列研究方法,回顾性收集并分析2018年11月至2019年5月在中山大学附属第六医院结直肠外科行经肛入路侧方淋巴结清扫手术治疗中低位直肠癌的5例患者的临床病理资料.4例男性,1例女性,年龄(43.2±13.2)岁,体质指数(21.2±2.6)kg/m2,肿瘤直径(3.2±2.4)cm,肿瘤下缘距肛门缘距离为(6.3±2.5)cm,有3例术前接受了新辅助化疗,5例患者术前TNM分期分别为:2例T3N1M0,1例为T3cN2aM0,1例为T3cN2bM0,1例为T2N1M0,患者术前均无肠梗阻.手术步骤:(1)全直肠系膜切除:采用常规经肛经腹联合方式游离全直肠系膜并切除,并清扫第252组和第253组淋巴结.(2)经肛侧方淋巴结清扫:尾向头侧依次清扫髂尾肌、尾骨肌、闭孔内肌表面脂肪淋巴组织(第283组淋巴结),沿髂内动脉由尾侧向头侧依次清扫第263d组和第263p组淋巴结,直至髂内外动脉分叉处的脂肪淋巴组织.(3)经肛门取出标本,将近端结肠与肛管吻合.观察患者术中及术后情况.结果 全组5例患者均顺利完成手术,无中转开腹.手术时间为(295.6±97.7)min,术中出血量为70(50~500)ml.术后标本长度为(12.9±3.0)cm,淋巴结送检数为(30.4±9.9)枚,其中4例侧方淋巴结阳性.肿瘤距远切缘距离为1.5(1.2~8.0)cm,所有病例标本切缘均为阴性.术后肛门排气时间为(4.2±1.6)d,术后自主排尿时间为(3.0±1.9)d,术后拔除引流管时间为(5.6±1.9)d,术后住院时间为(9.4±2.1)d.术后病理分期:1例T1N0M0,1例T2N1M0,1例为T3N2bM0,2例为T3N2M0,5例患者均为中分化腺癌.1例患者出现术后腹腔出血,经保守治疗后治愈,另4例无术后切口感染、骶前脓肿、盆腔脓肿、吻合口漏、吻合口狭窄等围术期并发症.全组无死亡病例,4例患者术后接受化疗.全部患者术后接受2~28周的随访,均未诉明显不适,造口患者造口排粪通畅.结论 经肛入路侧方淋巴结清扫手术可以达到中低位直肠癌扩大根治的目的,安全可行,是治疗中低位直肠癌合并侧方淋巴结肿大患者的新选择.

更多
abstracts:

Objective To evaluate the feasibility and safety of transanal lateral lymph node dissection for mid?low rectal cancer. Methods A descriptive case series research method was used. Clinical and pathological data of 5 mid?low rectal cancer patients who underwent transanal lateral lymph node dissection at Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat?sen University from November 2018 to May 2019 were retrospectively collected and analyzed. Of 5 cases, 4 were male and 1 was female with mean age of (43.2±13.2) years and mean body mass index of (21.2± 2.6) kg/m2; the mean diameter of tumor was (3.2±2.4) cm; the mean distance between tumor and anus was (6.3 ± 2.5) cm; 3 received preoperative neoadjuvant chemotherapy. In preoperative TNM staging, 2 cases were T3N1M0, 1 was T3cN2aM0, 1 was T3cN2bM0, and 1 was T2N1M0. All the patients had no intestinal obstruction before operation. Surgical methods: (1) total mesorectal excision: using general transanal and transabdominal methods to mobilize and resect total mesorectum, and dissect No.252, No.253 lymph nodes;(2) transanal lateral lymph node dissection: dissect the adipose lymphoid tissue on the surface of the iliococcygeal muscle, the coccygeal muscle, and the obturator muscle (the No. 283 lymph nodes) upward, and dissect No. 263d and No. 263p lymph nodes with fat tissue sequentially till the bifurcation of the internal and external iliac artery; (3) take out the specimen from anus, and make anastomosis between proximal colon and anal canal. Intraoperative and postoperative variables was observed. Results All the 5 patients completed surgery successfully, and no patient needed to convert to open approach. The mean operative time was (295.6±97.7) minutes, and the median intraoperative blood loss was 70 (50?500) ml. The mean length of specimen was (12.9±3.0) cm, and the mean number of harvested lymph node was 30.4±9.9. The positive lateral lymph nodes were founder in 4 patients. The median distance between tumor and distal resection margin was 1.5 (1.2?8.0) cm. The resection margin in all the patients was negative. The mean time to postoperative flatus was (4.2±1.6) days, the mean postoperative spontaneous urination was (3.0±1.9) days, time to drainage tube removal was (5.6±1.9) days, and the mean postoperative hospital stay was (9.4± 2.1) days. The postoperative TNM staging by pathology was 1 case with T1N0M0, 1 with T2N1M0, 1 with T3N2bM0, and 2 with T3N2M0. Five patients were moderately differentiated adenocarcinoma. Only 1 patient developed postoperative abdominal bleeding, who was healed after conservative treatment. The other 4 patients did not develop any perioperative complications, such as incision infection, presacral abscess, pelvic abscess, anastomotic leakage, or anastomotic stricture. Four patients underwent postoperative chemotherapy. All the patients were followed up for 2 to 28 weeks after surgery and they all felt well. The patients with stoma had fluent bowel. Conclusions Transanal lateral lymph node dissection is feasible and safe in the treatment of mid?low rectal cancer, which can achieve the purpose of extended radical resection of mid?low movement rectal cancer. Moreover, this procedure is a new method to treat rectal cancer patients with lateral lymph node metastasis.

More
作者: 曾子威 [1] 张兴伟 [1] 陈俊辑 [1] 黄亮 [1] 罗双灵 [1] 康亮 [1]
期刊: 《中华胃肠外科杂志》2019年22卷8期 781-785页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1671-0274.2019.08.014
发布时间: 2020-05-07
基金项目:
中山大学临床医学研究5010计划资助(2016005) Fund program: Project 5010 for Clinical Research of Sun Yat?sen University
  • 浏览:327
  • 下载:198

加载中!

相似文献

  • 中文期刊
  • 外文期刊
  • 学位论文
  • 会议论文

加载中!

加载中!

加载中!

加载中!

扩展文献

特别提示:本网站仅提供医学学术资源服务,不销售任何药品和器械,有关药品和器械的销售信息,请查阅其他网站。

  • 客服热线:4000-115-888 转3 (周一至周五:8:00至17:00)

  • |
  • 客服邮箱:yiyao@wanfangdata.com.cn

  • 违法和不良信息举报电话:4000-115-888,举报邮箱:problem@wanfangdata.com.cn,举报专区

官方微信
万方医学小程序
new翻译 充值 订阅 收藏 移动端

官方微信

万方医学小程序

使用
帮助
Alternate Text
调查问卷