腹腔镜直肠癌前切除低位吻合术中保留左结肠动脉可行性的临床分析

Clinical analysis of saving the left colic artery feasibility in laparoscopic anterior resection of rectal carcinoma

目的探讨直肠癌前切除低位吻合术（Dixon）中保留左结肠动脉（LCA）的可行性及应用价值。方法收集住院确诊直肠癌行Dixon手术的63例患者的临床资料，保留LCA组32例，不保留LCA组31例，比较两组患者术中出血量、手术时间、肠系膜下动脉淋巴结清扫数目、术后排气时间、吻合口缺血及吻合口漏，并随访两组患者转移及复发情况。结果两组术中出血量[（62．82±19．72）ml比（60．68±21．39）ml]、手术时间[（129．48±13．69）min比（129．45±19．78）min]、术中肠系膜下动脉淋巴结清扫数目[（2．93±1．54）枚比（3．21±1．30）枚]比较差异无统计学意义（P〉0．05）。保留LCA组术后排气时间（2．82±1．16）d，不保留LCA组（3．14±0．92）d，两组比较差异无统计学意义（P〉0．05）。保留LCA组无需游离结肠脾区及末端回肠造口，未发生吻合口缺血及吻合口漏，不保留LCA组中，4例近端肠管血运障碍加做末端回肠造口术，2例发生吻合口漏。术后随访2～24个月，不保留LCA组1例复发，4例远处转移，保留LCA组1例复发，3例远处转移。结论Dixon术中保留LCA，可以有效保障吻合口部血运，减少吻合口漏的发生。

Objective To explore the feasibility and application value of saving the left colic artery （LCA） feasibility in laparoscopic anterior resection of rectal carcinoma （Dixon）. Methods Collecting the clinical data of 63 patients diagnosed by rectal cancer and underwent laparoscopic anterior resection of rectal carcinoma from January 2009 to June 2012 ,including 32 cases underwent saving LCA （saving LCA group） and 31 cases not saving LCA （no saving LCA group）. The amount of bleeding volume, operation time, the number of lymph node dissection of inferior mesenteric artery in the operation, pass wind time, anastomotic ischemia, anastomotic leakage, and recurrence and metastasis were compared. Results No significant difference was found in the bleeding volume [ （62.82 ± 19.72） ml vs. （60.68 ± 21.39） ml ], operation time [（129.48 ± 13.69） rain vs. （129.45 ± 19.78） mini,the number of lymph node dissection of inferior mesenteric artery in the operation （2.93 ± 1.54 vs. 3.21 ：t： 1.30） between two groups （P 〉0.05）. No significant difference was found in pass wind time [ （2.82 ± 1.16） d vs. （3.14 ± 0.92） d] after operation（P〉 0.05 ）. The saving LCA group was not performed freeing colon splenic area and the terminal ileum stoma, the proximal intestinal blood circulation disorder and anastomotic leakage were not found. In no saving LCA group, 4 cases were underwent ileostomy because of the proximal intestinal blood circulation disorder,2 cases occurred anastomotic leakage. During the follow-up of 2 - 24 months, 1 case had a recurrence, 3 cases had metastasis in saving LCA group. 1 case had a recurrence, 4 cases had metastasis in no saving LCA group. Conclusion Saving LCA in Dixon operation can ensure the anastomotic part with adequate blood supply, and reduce the occurrence of anastomotic leakage.