筋膜导向解剖入路行腹腔镜直肠前切除术淋巴结清扫的临床效果分析OA
Clinical efficacy of fascia-guided anatomical approach in lymph node dissection during laparoscopic anterior resection of rectum
目的 探讨筋膜导向解剖入路在进展期直肠癌腹腔镜直肠前切除术淋巴结清扫中的临床效果.方法 回顾性分析2020 年8 月至2023 年8 月收治的 90 例进展期直肠癌患者的临床资料,均行标准腹腔镜直肠前切除术(包括全直肠系膜切除),根据手术入路分为对照组和观察组,各45 例,分别采用以肠系膜下动脉为中心的血管导向解剖入路和以 Toldt 筋膜为导向的筋膜导向解剖入路行淋巴结清扫.比较两组手术相关指标、临床疗效以及近期并发症.随访 12 个月,采用 Kaplan-Meier 法进行生存分析.结果 组间比较,观察组淋巴结清扫数量、总有效率均高于对照组(P<0.05),并发症发生率低于对照组(P<0.05).随访1 年,观察组死亡 4 例,疾病进展 9 例,对照组死亡 6 例,疾病进展15 例;Kaplan-Meier 生存分析显示,两组患者术后 1 年总生存率及无进展生存率差异均无统计学意义(Log-rank χ2=0.546,P=0.460;Log-rank χ2=2.258,P=0.133).结论 筋膜导向解剖入路行腹腔镜直肠前切除术淋巴结清扫较血管导向解剖入路淋巴结清扫数目更多,近期疗效更优且并发症发生率更低,两种入路短期生存结局相近.
Objective To investigate the clinical efficacy of the fascia-guided anatomical approach for lymph node dissection during laparoscopic anterior resection for advanced rectal cancer.Methods A retrospective analysis was conducted on the clinical data of 90 patients with advanced rectal cancer admitted between August 2020 and August 2023.All patients underwent standard laparoscopic anterior resection with total mesorectal excision.Based on the surgical approach,patients were divided into a control group and an observation group(45 patients each).The control group underwent lymph node dissection via a vessel-oriented anatomical approach centered on the inferior mesenteric artery,while the observation group underwent the procedure via a fascia-guided anatomical approach using the Toldt fascia as a landmark.Surgery-related indicators,clinical efficacy,and the incidence of short-term complications were compared between the two groups.All patients were followed up for 12 months,and survival analysis was performed using the Kaplan-Meier method.Results Compared with the control group,the observation group showed a significantly higher number of dissected lymph nodes and a higher overall effective rate(P<0.05),while the incidence of complications was significantly lower(P<0.05).During the 1-year follow-up,there were 4 deaths and 9 cases of disease progression in the observation group,compared to 6 deaths and 15 cases of disease progression in the control group.Kaplan-Meier survival analysis revealed no statistically significant differences in the 1-year overall survival and progression-free survival rates between the two groups(Log-rank χ2=0.546,P=0.460,Log-rank χ2=2.258,P=0.133).Conclusion In laparoscopic anterior resection of the rectum,the fascia-guided anatomical approach for lymph node dissection yields a higher number of dissected lymph nodes,superior short-term efficacy,and a lower complication rate compared with the vascular-oriented approach based on appropriate indication selection,with comparable short-term survival outcomes between the two approaches.
曹宇;殷杰;朱日祥;王怀德
海安市人民医院普外科,江苏海安 226600海安市人民医院普外科,江苏海安 226600海安市人民医院普外科,江苏海安 226600海安市人民医院普外科,江苏海安 226600
直肠肿瘤筋膜导向解剖入路腹腔镜手术直肠前切除术
rectal neoplasmsfascia-guided anatomical approachlaparoscopyanterior resection of rectum
《中国现代手术学杂志》 2026 (2)
114-120,7
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