腹腔镜下低位结扎肠系膜下动脉的Dixon观察

Preservation of the Left Colonic Artery on Laparoscopic Anterior Resection of Colorectal Cancer

目的:探讨腹腔镜下低位结扎肠系膜下动脉的直肠癌前切除低位吻合术(Dixon)的可行性及应用价值。方法:将拟施行腹腔镜Dixon的60例患者随机分为高位结扎组与低位结扎组,每组30例。比较2组手术时间、术中出血量、吻合口张力、术中并发症、肠系膜下动脉行径周围淋巴结清扫的个数及病理情况,观察术后局部复发,淋巴结转移及吻合口漏的发生率。结果:60例手术均获成功。2组在手术时间、出血量、吻合口张力、术中并发症及淋巴结清扫数目方面均无显著性差异。术后高位结扎组4例患者发生吻合口瘘,均经保守治疗痊愈,低位结扎组无吻合口漏的发生,组间比较有显著性差异(P<0.05)。术后半年均无复发病例。结论:腹腔镜下保留左结肠动脉的Dixon手术安全可行,可能有助于降低术后吻合口瘘的风险。

Objective：To evaluate the feasibility and efficacy of preservation of the left colonic artery on laparoseopie anterior resection of eoloreetal cancer （Dixon）. Methods：60 patients with rectal cancer were randomly divided into two groups of low ligation and hight ligationfor laparoseopic Dixon surgery, each group of 30 patients. The operative time, blood loss, anastomotic tension, intraoperative complications, number and histopathologieal features of the dissected lymph nodes of surrounding the inferior mesenteric artery, and the rates of local recurrence, lymph node metastasis and anastomotie leakage were analyzed. Results： The operation was successfully in all cases. The operative time, blood loss, anastomotic tension, intraoperative complications, and the number of dissected lymph nodes of surrounding the inferior mesenteric artery were no differences in two groups. In hight ligation group, 4 patients had anastomotie leakage, and were cured by conservative treatment; in low ligation group, no anastomotic leakage occured. There was statistically different between the two groups （ P 〈 0.05 ）. There was no recurrence after six months in all cases. Conclusion： Preservation of the left colonic artery on laparoscopie anterior resection of colorectal cancer are safe and feasible, may reduce the risk of anastomotic leakage.