腹腔镜直肠癌前切除术中保留左结肠动脉与否的临床对照研究

A Comparative Study of Laparoscopic Anterior Resection of Rectal Carcinoma with and without Preservation of the Left Colonic Artery

目的探讨腹腔镜直肠癌前切除术中处理肠系膜下动脉时保留左结肠动脉（left colic artery，LCA）的可行性与应用价值。方法回顾性分析我院2009年3月～2012年12月113例腹腔镜直肠癌前切除术的临床资料，术者随意分为两组，其中保留LCA组72例，不保留LCA组41例，比较2组术中出血量、手术时间、术后排气时间、末端回肠造口情况、肠系膜下动脉（inferior mesenteric artery，IMA）根部淋巴清扫数目、IMA根部淋巴结转移率及预后情况。结果2组术中出血量[（60．8±23．8）mlVS．（55．7±22．7）ml，t=1．115，P=0．267]，手术时间[（133．8±14．6）minvs．（128．3±21．1）min，t=1．623，P=0．107]，术后排气时间[（2．6±0．8）dVS．（2．8±0．9）d，t=-1．161，P=0．248]，IMA根部淋巴结清扫数目[（3．0±1．3）VS．（3．3±1．1），t=-1．237，P=0．219]，IMA根部淋巴结转移率[6．9％（5／72）VS．7．3％（3／41），x。：0．006，P=0．941]差异均无显著性。保留LCA组均无须游离结肠脾曲及做末端回肠造口；不保留LCA组3例因近端肠管血运障碍需游离结肠脾曲（P=0．046），3例吻合后加做末端回肠造口（P=0．046）。保留LCA组术后无吻合漏，不保留LCA组2例吻合口漏（P=0．130）。2组术后随访3—48个月，中位随访24个月，保留LCA组1例局部复发，4例肝转移，不保留LCA组1例局部复发（P=1．000），2例肝转移（P=1．000）。结论腹腔镜直肠癌前切除术中处理IMA时保留LCA可以有效保障近端肠管血运。

Objective To explore the feasibility and value of preservation of the left colonic artery （LCA） when treating the inferior mesenteric artery in laparoscopic anterior resection of rectal carcinoma. Methods The clinical data of 113 cases of laparuseopie rectal anterior resection in our hospital from March 2009 to December 2012 were retrospectively analyzed, including 72 cases with preservation of LCA and 41 cases without preservation of LCA. The blood loss, operative time, postoperative exhaust time, terminal ileum stoma, the number of lymph nodes removed around the root of inferior mesenteric artery （IMA） , the rate of lymph node metastasis around the root of IMA and prognosis were compared between the two groups. Results No significant difference was found in intraoperative blood loss [（60.8 ±23,8） ml vs. （55.7 ±22.7） ml, t=1.115, P=0.2671, operative time [（133.8±14.6） min vs. （128.3±21.1） min, t=1.623, P=0.107], postoperative exhaust time [（2.6±0.8） dvs. （2.8±0.9） d, t= -1.161, P= 0.248], the number of lymph nodes removed around the root oflMA （3.0±1.3 vs. 3.3 ±1.1, t= -1.237, P=0.219）, and the rate of lymph node metastasis around the root of IMA [6.9% （5/72） vs. 7.3% （3/41）,Xe =0.006, P=0.941] between the two groups. No case in the preservation group needed to free the splenic flexure of colon and to make the terminal ileum stoma, while 3 eases of the none-preservation group needed to free splenic flexure of colon because of blood supply disorder in the proximal intestine （P = 0.046）, and 3 cases underwent terminal ileum stoma following anastomosis （P = 0.046）. No anastomotic leakage occurred in the preservation group, while 2 cases of anastomotie leakage occurred in the none-preservation group （P = 0. 130）. In the follow-up of 3 to 48 months （ median, 24 months） of the two groups, 1 case had local recurrence, 4 cases had liver metastasis in the preservation group while 1 case had local recurrence （ P = 1. 000） and 2 cases had liver metastasis （ P = 1. 000） in the none-preservation group. Conclusion Laparoseopie anterior resection of rectal carcinoma with preservation of the LCA when treating the inferior mesenterie artery can effectively retain the blood supply of proximal intestine.