保留左结肠动脉(升支)的腹腔镜直肠癌全切除术的疗效观察

Clinical effect of laparoscopic resection for rectal cancer in the preservation of superior branch of left colic artery

目的探讨保留左结肠动脉(升支)的腹腔镜直肠癌全切除术在直肠癌患者手术中的效果。方法选取2011年1月~2015年6月我科收治的需进行腹腔镜直肠癌全切除术的患者84例作为研究对象,按照是否保留左结肠动脉升支分为保留LCA组和不保留组,各42例;两组患者均进行腹腔镜直肠癌全切除术,保留LCA组术中保留左结肠动脉升支,不保留组为肠系膜下动脉根部结扎;对两组患者术中行预防性回肠造口情况、游离结肠脾曲情况、根部淋巴结清扫所需时间、系膜根部淋巴结清扫个数,术中出血量、术后排气时间、吻合口瘘发生情况进行记录,同时比较随访结果。结果本研究所有患者均顺利完成手术,无中转开腹手术者。两组术中出血量及术后排气时间均无显著差异(P>0.05);不保留组患者预防性回肠造口、游离脾曲及吻合口瘘发生率虽高于保留LCA组,但差异亦无统计学意义(P>0.05);系膜根部淋巴结清扫个数不保留组高于保留组,但组间差异无统计学意义(P>0.05);根部淋巴结清扫所需时间不保留组显著低于保留组(P<0.05);保留肠系膜下动脉情况不保留组显著优于保留组(P<0.05);两组随访时间无统计学差异(P>0.05);随访中复发率保留组高于不保留组,但组间比较差异无统计学意义(P>0.05)。结论保留左结肠动脉升支的腹腔镜直肠癌全切除术可相对降低患者预防性回肠造口、游离脾曲、吻合口瘘、术后排气时间(肠道功能恢复)及复发率,有效保障近端肠管血运,值得临床借鉴。

Objective To investigate the clinical effect of laparoscopic resection for rectal cancer in the preservation of superior branch of left colic artery. Methods 82 cases which should carried on laparoseopic resection for rectal cancer in our hospital from Jan. 2011 to dun. 2015 were selected as the study objects. According to weather retain superior branch of left colic artery, they were divided into preservation LCA group （42 cases） and non- preservation LCA group （42 cases）. All the eases were taken laparoscopic resection for rectal cancer. The cases in preservation LCA group with left colic artery reminded and the non-preservation LCA group dido＇ t preserve it. The condition of ileostomy and pancreas-oriented mobilization, time for removing the root lymph nodes, number of root lymph nodes removed, blood loss during operation, postoperative exhaust time, the occurrence of anastomotic fistula and follow-up outcome between the two groups were compared. Results All the patients were successfully operated, with no laparotomy： There was no significant difference of blood loss during operation and postoperative exhaust time between the two groups （P 〉0.05）. The occurrence rate of ileostomy, pancreas-oriented mobilization and occurrence of anastomotic fistula in non-preservation LCA group were higher than preservation LCA group, but without significant difference （P 〉 0.05）. The number of root lymph nodes removed in non-preservation LCA group was higher than preservation LCA group, but without significant difference （P 〉 0.05）. The time for removing the root lymph nodes in non-preservation LCA group was significantly lower than preservation LCA group （P 〈 0.05）. Retaining the inferior mesenteric artery in non-preservation LCA group was significantly better than in preservation LCA group （P 〈 0.05）. There was no significant difference of follow-up time between the two groups （P 〉 0.05）. During the follow-up, the occurrence rate was higher than non-preservation LCA group. However, there was no significant difference between these two groups （P 〉 0.05）. Conclusion Laparoscopic resection for rectal cancer in the preservation of superior branch of left colic artery can reduce the occurrence rate of ileostomy, pancreas-oriented mobilization and occurrence of anastomotic fistula, andensure the blood circulation of proximal intestinal canal relatively. Itis worthy of clinic application.