腹腔镜下保留直肠上动脉的D3淋巴结廓清术在乙状结肠癌根治术中的临床应用

Clinical application in laparoscopic D3 lymph node dissection for sigmoid cancer with preservation of superior rectal artery

目的探讨腹腔镜下保留直肠上动脉(SRA)的D3淋巴结廓清术在乙状结肠癌根治术中应用的临床可行性、安全性及有效性。方法2016年1月~2018年12月间收治的乙状结肠癌病人45例,根据治疗方法不同分为两组,保留SRA组25例,采用腹腔镜下保留SRA的D3淋巴结廓清术,不保留SRA组20例,行直接离断肠系膜下动脉根部不保留直肠上动脉手术。比较两组术中出血量、手术时间、肠道功能恢复以及术后并发症等指标。结果保留SRA组和不保留SRA手术组手术时间分别为(202.2±46.5)分钟和(147.5±37.3)分钟,术后肠道功能恢复时间分别为(2.1±1.1)天和(3.1±1.3)天,住院时间分别(8.1±0.9)天和(11.5±1.1)天,两组比较差异均有统计学意义(P<0.05);保留SRA组和不保留SRA手术组术中出血量分别为(65.3±10.2)ml和(59.2±9.9)ml,淋巴结清扫数量分别为(14.4±3.5)枚和(15.3±4.2)枚,术后并发症发生率分别为8%(2/25)和15%(3/20),两组比较差异均无统计学意义(P>0.05)。结论腹腔镜下乙状结肠癌根治术保留直肠上动脉的D3淋巴结廓清术安全可行,未增加并发症发生率,有助于术后肠功能恢复。

Objective To investigate the feasibility,safety and efficacy of laparoscopic D3 lymph node dissection for sigmoid cancer with preservation of superior rectal artery.Methods Laparoscopic D3 lymph node dissection of superior rectal artery was performed in 25 cases and direct dissection of inferior mesenteric artery without preservation of superior rectal artery in 20 cases at the same time.The clinicopathological data,operative time,intestinal function recovery and postoperative complications were compared between the two groups.ResultsThe operative time in SRA group and non-SRA group was(202.2±46.50)min and(147.5±37.3)min,and the recovery time of intestinal function was(2.1±1.1)days and(3.1±1.3)days,The hospitalization time was(8.1±0.9)days and(11.5±1.1)days,there were significant difference between the two groups(P<0.05).The intraoperative bleeding volume in the SRA-sparing group and the non-SRA-sparing group was(65.3±10.2)ml and(59.2±9.9)ml,The number of lymph node dissectionwas(14.4±3.5)and(15.3±4.2),and the incidence of postoperative complications was 8%(2/25)and 15%(3/20),there were no significant difference between the two groups(P>0.05).Conclusions The laparoscopic D3 lymph node dissection with preservation of superior rectal artery for sigmoid cancer is safe and feasible,the patients can recover early,and without increasing complication incidence,Thus has great clinical value.