乙状结肠癌根治术中保留左结肠动脉的疗效及可行性分析

目的 探讨乙状结肠癌根治术中保留左结肠动脉的疗效及可行性.方法 研究分析2012年4月至2014年3月期间行腹腔镜乙状结肠癌根治术的患者,其中21例对肠系膜下动脉进行高位结扎,39例对肠系膜下动脉进行低位结扎并保留左结肠动脉.结果 高位结扎组患者术中残端缺血性改变发生率为9.5%,显著高于低位结扎组;高位结扎组患者术中平均出血量为（91.0±14.8）ml,显著低于低位结扎组（105.5±15.7）ml.其他各项指标两组之间均未见明显差异.术后随访结果显示,低位结扎组患者4例复发,复发率为10.25%;高位结扎组患者3例复发,复发率为14.28%,两组之间差异无统计学意义（P〉0.05）.结论 在乙状结肠癌根治腹腔镜手术中保留左结肠动脉可能会增加术中出血量,但对于手术疗效无影响,不会增加术后并发症的发生率,同时可以更好地保留肠段吻合口血供.因此,乙状结肠癌根治术中保留左结肠动脉在临床上具有可行性,应根据患者实际情况选择手术方式.

Objective To investigate the efficacy and feasibility of left colonic artery preservation during radical operation of sigmoid colon cancer. Methods 60 patients who underwent laparoscopic resection of sigmoid colon cancers were analyzed in the study,including 21 high ligations of the IMA and 39 low ligations with preservation of the LCA from April 2012 to March 2014. Results The incident of ischemic changed during operation in rectal stump of high ligation group was 9.5%,which was significantly higher than low ligation group. The average intraoperative blood loss of high ligation group was 91.0±14.8 ml,which was significantly lower than low ligation group. No significantly differences in other indicators were observed between the two groups. The following up showed that there were 4 patients in low ligation group and 3 patients in high ligation group were with recurrence,and the recurrence rates were 10.25% and 14.28% respectively,which had no significant difference. Conclusion Laparoscopic lymphadenectomy around the IMA with preservation of the LCA may increase the blood loss during the operation but generally results in acceptable clinical outcomes and provides better blood supply for proximal colon and anastomosis,which is acceptable in clinical.