腹腔镜直肠癌前切除术术中保留左结肠动脉的临床价值探讨

Clinical value of saving the left colic artery in laparoscopic assisted anterior resection of rectal cancer

目的探讨腹腔镜直肠癌前切除术术中处理肠系膜下动脉时保留左结肠动脉(left colic artery,LCA)的临床价值。方法回顾性分析昆明医科大学附属延安医院2014年1月至2015年6月间71例行腹腔镜直肠癌前切除术患者的临床资料,按照术中是否保留左结肠动脉进行分组,其中保留LCA组36例,不保留LCA组35例,比较两组的术中出血量、手术时间、肠系膜淋巴结清扫数目、术后是否发生吻合口瘘、术后1年复查有无肿瘤转移等方面的差异。结果两组的术中出血量相当[(81.7±19.5)ml vs(72.9±21.9)ml,t=1.769,P=0.081];手术时间,保留LCA组较不保留LCA组稍长[(135.6±27.2)min vs(124.9±38.3)min,t=1.354,P=0.181];清扫淋巴结数量[(12.0±2.8)枚vs(12.5±2.6)枚,t=-0.803,P=0.425],两组比较,差异无统计学意义(P<0.05)。保留LCA组术后无吻合口瘘患者,不保留LCA组4例发生吻合口瘘,发生率11.4%,高于保留LCA组,两组比较,差异有统计学意义(P=0.037)。术后1年复查腹部CT,保留LCA组2例发生肝转移,不保留LCA组3例发生肝转移,两组比较,差异无统计学意义(P=0.620)。结论腹腔镜直肠癌前切除术术中处理肠系膜下动脉时保留LCA可以有效保障近端肠管血运,减少吻合口瘘的发生,并不影响第3站淋巴结的清扫及患者预后。

Objective To analyse the clinical value of saving the left colic artery in laparoscopic assisted anterior resection of rectal cancer when processing inferior mesenteric artery. Methods The clinical data of 71 patients who underwent laparoscopic assisted anterior resection of rectal cancer from Jan. 2014 to Jun. 2015 were retrospectively analysed, these patients were divided into two groups based on saving LCA or not. The amount of bleeding volume, operation time, the number of mesenteric lymph nodes dissected in the operation , the occurrence of anastomotic leakage, recurrence and metastasis after 1 year, were compared. Results No significant difference was found between two groups in the bleeding volume[ （81.7±19. 5 ） ml vs （72. 9 ± 21.9） ml,t=1. 769,P=0. 081 ] ,and the number of mesenteric lymph nodes dissected in the operation [（12.0 ± 2.8） vs （ 12. 5±2.6）,t = -0. 803 = 0. 425]（P 〈 0. 05 ） . The operation time insaving LCA group was longer than the other group [ （ 135. 6 ± 27. 2） min （ 124. 9 ± 38.3）min]. None of anastomotic leakage occurred in the saving LCA group, while four cases of anastomotic leakage occurred in no saving LCA group. In the one year follow- up of the two groups , 2 cases were found with liver metastasis in the saving LCA group , while 3 cases were found with liver metastasis in no saving LCA （P=0. 620）. Conclusions Saving LCA in laparoscopic assisted anterior resection of rectal cancer when processing inferior mesenteric artery can effectively guarantee the proximal bowel blood supply, reduce the occurrence of anastomotic leakage, while insure the number of mesenteric lymph nodes dissected in the operation, and the prognosis of patients.