| Objective By observing the situation of 113 mesenteric artery(IMA)root lymph nodes(253 lymph nodes)in our hospital,we explored the definition,number and indications of 253 lymph nodes,related risk factors and dissection related to the metastasis of sub-mesenteric artery root Clinical significance and safety.Methods The clinical data of 113 patients with adenocarcinoma of the sigmoid colon and middle and upper rectum of the laparoscopic lymph node dissection in our department from April 2019 to April 2020 were collected for retrospective clinical analysis.All patients with colorectal cancer completed 253 stations of laparoscopic lymph node dissection,intraoperative lymph node dissection,using Kanaline lymph tracer markers before dissection,observation of 253 lymph node reflux,redefinition and number of 253 lymph nodes determine.To determine the indications of 253 lymph node dissection for the conformity rate of 253 lymph node positive patients and preoperative imaging after postoperative pathological examination,collect relevant clinical factors including gender,age,preoperative serum carcinoembryonic antigen(CEA)level,and 253 The imaging characteristics of lymph nodes,the largest diameter of the tumor,the location of the tumor,the general shape of the tumor,the degree of tumor invasion,the vascular invasion,and the degree of tumor differentiation.Statistically related data was analyzed using SPSS 21.0 software,and correlation factor analysis was performed using ?2 test.The test standard was statistically significant with p <0.05 as the difference,to determine the related risk factors of 253 lymph node metastasis and the clinical significance of dissection.Results A total of 113 patients were enrolled in this study.All patients underwent laparoscopic D3 dissection of the left colonic artery without conversion to open laparotomy.113 patients successfully completed laparoscopic dissection and found through lymph node tracer The blue-stained lymph nodes range from the right side to the right edge of the abdominal aorta,the left side to the ascending part of the left colonic artery,and the lower edge to the horizontal part of the left colonic artery(LCA)starting part parallel to the right side of the abdominal aorta,From the upper edge to the flexor ligament.After operation,each patient detected an average of 26 lymph nodes(median 6-57),of which 253 stations had a median of 5 per case(median 1-14).Of the 113 patients,15(13.2%)had 253 regional lymph node metastases.The imaging findings of 15 patients suggested that IMA root lymph node metastasis be considered,including 9 males(9/64,14.0%);6 female patients(6/49,12.2%),and there was no statistically significant difference between men and women(?2 = 0.80,p = 0.778);7 patients with age> 60 years(7/48,14.5%);65 patients with age ?60 years,8 patients(8/65,12.3%),the difference between the two was not statistically significant(?2 = 0.124,p = 0.725);10 patients with serum CEA level> 5(10/44,22.7%);5 patients with serum CEA level ? 5(5/69,7.2%),which existed between the two groups There were significant statistical differences(?2 = 5.593.,P = 0.018);4 patients(4/70,5.7%)with the largest tumor diameter ?5;11 patients(11/43,11)with the largest tumor diameter> 5 25.6%),there were significant statistical differences between the two groups(?2 = 9.133.,P = 0.003);6 patients in rectal cancer group(6/41,14.6%);9 patients in colon cancer group(9/72),12.5%),the difference between the two was not statistically significant(?2 = 0.103,p = 0.748);2 patients with raised tumor group(2/22,9.0%);6 patients with ulcer tumor group(6/58,10.3%),7 patients with invasive tumor group(7/33 21.2%),the difference between the three groups was not statistically significant(?2 = 2.573.,P = 0.276);p T1-2 patients group,0 patients(0/14,0.0%);p T3 patients group 7 patients(7 / 81,8.6%),8 patients in p T4 phase group(8/18,44.4%),there were significant statistical differences between the three groups(?2 = 18.844.,P = <0.001);12 patients(12/77,15.6%)with lymph node detection ?21;3 patients(3/36,8.3%)with lymph node detection <21(3/36,8.3%)No statistical significance(?2 = 1.120,p = 0.290);15 patients with lymphatic infiltration group(15/58,25.9%),0 patients with non-infiltration lymphatic group(0/55,0.0%),two groups There was a statistically significant difference(?2 = 16.401,p = <0.001);0 patients in the highly differentiated patient group(0/10,0.0%);8 patients in the moderately differentiated patient group(8/80,10.0%),low There were 7 patients(7/23,30.4%)in the differentiated patient group,and there were significant statistical differences between the three groups(?2 = 8.159,p = 0.017).Among them,3 patients had grade A anastomotic leakage after operation(3/113,2.6%),7 patients had urinary retention after pulling out the urinary catheter(7/113,6.2%),and 2 patients had auxiliary wound infection(2/113,1.7%),there were no cases of perioperative deaths,no cases of related reproductive dysfunction,the median hospital stay was 8(6-14)days,and the median time spent on D3 dissection was 18(15-27)minutes,the amount of blood loss during surgery is 60(10-300)ml.Conclusion 1.According to the results of this study,253 lymph nodes should be defined as the right side to the right edge of the abdominal aorta,the left side to the ascending part of the left colon artery,and the lower edge to the horizontal part of the beginning of the left colon artery(LCA).The right margin of the abdominal aorta,from the upper margin to the flexor ligament.2.The median number of detected lymph nodes in 253 stations in this study was 5 per case(median was 1-14).The median time spent in the D3 dissection process was 18(15-27)minutes.Short,the amount of blood loss during the operation is 60(10-300)ml,the amount of bleeding is less,and the overall complication rate is relatively low.This study believes that LCA-preserving D3 lymph node dissection is technically safe and feasible.3.The maximum tumor diameter,tumor differentiation,lymphatic vessel infiltration,tumor infiltration depth,and preoperative CEA level were significantly correlated with IMA root lymph node metastasis.4.Among the 113 patients included in this study,253 lymph nodes were positive,accounting for 13.2%.In 15 patients with positive lymph nodes,enhanced CT suggested that 253 sites of lymph node metastasis were considered.This study believes that it is not appropriate to cooperate with preventive 253 lymph node dissection.For patients diagnosed with preoperative imaging examination or suspected of positive IMA lymph node metastasis,253 stations of lymph node dissection should be routinely performed. |
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