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的可行性评价

Feasibility evaluation on preservation of left colonic artery in dealing with inferior mesenteric artery in laparoscopic anterior resection of rectal carcinoma

目的 探讨腹腔镜直肠癌前切除术中处理肠系膜下动脉（IMA）时保留左结肠动脉（LCA）的可行性与应用价值.方法 回顾性分析2010年4月至2013年10月72例腹腔镜直肠癌前切除术患者的临床资料,患者按随机数字表法分为两组,其中保留LCA 32例（观察组）,不保留LCA40例（对照组）,比较两组术中出血量、手术时间、术后排气时间、末端回肠造口情况、IMA根部淋巴结清扫数目、IMA根部淋巴结转移及预后情况.结果 观察组和对照组术中出血量、手术时间、术后排气时间、IMA根部淋巴结清扫数目、IMA根部淋巴结转移率比较差异均无统计学意义（P＞0.05）.观察组均无需游离结肠脾区及做末端回肠造口;而对照组3例因近端肠管血运障碍需游离结肠脾曲（P=0.046）,4例吻合后加做末端回肠造口（P=0.042）.观察组术后无吻合口漏,而对照组术后有2例吻合口漏（P=0.090）.两组术后随访6～48个月,局部复发率及肝转移率比较差异无统计学意义（P＞0.05）.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 left colonic artery （LCA） in dealing with inferior mesenteric artery （IMA） in laparoscopic anterior resection of rectal carcinoma.Methods The clinical data of 72 cases of laparoscopic anterior resection of rectal carcinoma from April 2010 to October 2013 were retrospectively analyzed including 32 cases with preservation of LCA （observation group） and 40 cases without preservation of LCA （control group）.The blood loss,operative time,postoperative exhaust time,terminal ileum stoma,the number of lymph nodes removed around the root of IMA,the rate of lymph node metastasis around the root of IMA and prognosis were compared between two groups.Results There was no significant difference in the blood loss,operative time,postoperative exhaust time,terminal ileum stoma,the number of lymph nodes removed around the root of IMA,the rate of lymph node metastasis around the root of IMA between two groups （P ＞ 0.05）.No case in observation group needed to free the splenic flexure of colon and to make the terminal ileum stoma,while 3 cases in control group needed to free splenic flexure of colon because of blood supply disorder in the proximal intestine （P =0.046）,and 4 cases underwent terminal ileum stoma following anastomosis （P =0.042）.No anastomotic leakage occurred in observation group,while 2 cases of anastomotic leakage occurred in control group（P =0.090）.After followed up for 6-48 months,no significant difference was found in local recurrence and liver metastasis in two groups （P ＞ 0.05）.Conclusion Laparoscopic anterior resection of rectal carcinoma with preservation of LCA in dealing with IMA can effectively retain the blood supply of proximal intestine.