CAJ | 학술논문

目的研究直肠癌肠系膜下动脉(inferior mesenteric artery,IMA)根部淋巴结的转移规律,探讨IMA根部淋巴结清扫在直肠癌根治术中的意义.方法回顾性分析北京大学第一医院2005-2008年间接受直肠癌手术并进行IMA根部淋巴结清扫的105例直肠癌患者的临床病理资料,对IMA根部淋巴结转移的影响因素进行单因素及多因素分析,并与同期收治的未行IMA根部淋巴结清扫的204例直肠癌患者的术后5年生存率及局部复发率进行比较.结果 IMA根部淋巴结转移率为9.5％ (10/105),淋巴结有转移患者的5年生存率(20.0％,2/10)明显低于无转移者(76.9％,70/91)(x2=21.546,P＜0.05).多因素分析显示肿瘤浸润深度(Wald=5.764,P＜0.05)为pT3、pT4,分化程度为低分化、未分化的直肠癌患者(Wald =7.818,P＜0.05),IMA根部淋巴结转移率明显增高.IMA根部淋巴结清扫与否的5年生存率分别为71.3％(72/101)和70.6％(142/201),差异无统计学意义(x2=0.000,P=0.995);局部复发率分别为1.9％ (2/105)和7.4％ (15/204),差异有统计学意义(x2=3.958,P＜0.05).结论肠系膜下动脉根部淋巴结清扫并不能提高直肠癌患者的5年生存率,但是可以降低局部复发率；对于肿瘤浸润深度为T3、T4,分化程度为低分化、未分化的直肠癌,肠系膜下动脉根部淋巴结清扫降低了局部复发率.
목적 연구직장암장계막하동맥(inferior mesenteric artery,IMA)근부림파결적전이규률,탐토IMA근부림파결청소재직장암근치술중적의의.방법 회고성분석북경대학제일의원2005-2008년간접수직장암수술병진행IMA근부림파결청소적105례직장암환자적림상병리자료,대IMA근부림파결전이적영향인소진행단인소급다인소분석,병여동기수치적미행IMA근부림파결청소적204례직장암환자적술후5년생존솔급국부복발솔진행비교.결과 IMA근부림파결전이솔위9.5％ (10/105),림파결유전이환자적5년생존솔(20.0％,2/10)명현저우무전이자(76.9％,70/91)(x2=21.546,P＜0.05).다인소분석현시종류침윤심도(Wald=5.764,P＜0.05)위pT3、pT4,분화정도위저분화、미분화적직장암환자(Wald =7.818,P＜0.05),IMA근부림파결전이솔명현증고.IMA근부림파결청소여부적5년생존솔분별위71.3％(72/101)화70.6％(142/201),차이무통계학의의(x2=0.000,P=0.995);국부복발솔분별위1.9％ (2/105)화7.4％ (15/204),차이유통계학의의(x2=3.958,P＜0.05).결론 장계막하동맥근부림파결청소병불능제고직장암환자적5년생존솔,단시가이강저국부복발솔；대우종류침윤심도위T3、T4,분화정도위저분화、미분화적직장암,장계막하동맥근부림파결청소강저료국부복발솔.
Objective To investigate factors affecting the metastasis of lymph nodes around the root of inferior mesenteric artery(IMA) in rectal cancer,and the significance of root lymph nodes dissection of IMA in radical surgery for rectal cancer.Methods Clinicopathological data of 105 rectal cancer patients undergoing root lymph node dissection of IMA during radical resection in Peking University First Hospital from January 2005 to December 2008 were analyzed retrospectively.Rectal cancer patients without root lymph node dissection of IMA during the same period served as control.Results were compared between these two groups for survival and local recurrence rates.Results The rate of lymph node metastasis around the origin of IMA was 9.5％ (10/105).The five-year survival rate in patients with IMA root nodal dissection was 71.3％,and that without was 70.6％ (P =0.995),while the local recurrence was respectively 1.9％ and 7.4％ (P ＜ 0.05).In multivariate analyses,IMA root nodal metastasis occurred more frequently in patients with pT3 and pT4 tumor(Wald =5.764,P ＜ 0.05) and poorly differentiated tumor(Wald =7.818,P ＜ 0.05).Conclusions Root lymph nodes dissection of IMA could not increase five-year survival rate,but it could reduce local recurrence rate in patients with rectal cancer.In radical surgery of rectal cancer,lymphadenectomy of IMA root should be performed in patients with T3 and T4 tumor with poorly differentiated tumor,so as to reduce local recurrence rate.