腹腔镜直肠癌根治术中保留左结肠动脉的临床价值

Clinical significance of preservation of left colon artery in laparoscopic radical surgery for rectal cancer

目的探讨腹腔镜直肠癌根治术中保留左结肠动脉的临床价值。方法腹腔镜直肠癌根治术患者89例,术中保留左结肠动脉46例(保留组),不保留左结肠动脉43例(不保留组)。比较两组手术时间、术中出血量、淋巴结清扫数目、回肠造口和并发症,观察术后2年肿瘤局部复发及转移率。结果保留组手术时间较不保留组长[(187.10±41.37)min vs.(152.30±31.34)min](P<0.05),两组术中出血量及清扫淋巴结数目差异无统计学意义(P>0.05)。保留组术中无回肠造口、术后无吻合瘘发生;不保留组术中回肠造口5例,术后吻合口瘘3例。术后3个月,保留组无吻合口狭窄,不保留组吻合口狭窄7例。术后2年,保留组吻合口复发3例,肝转移4例;不保留组吻合口复发4例,肝转移2例。结论腹腔镜直肠癌根治术中保留左结肠动脉可以有效保证吻合口血供,减少吻合口狭窄的发生。

Objective To explore the clinical value of the preservation of left colon artery in laparoscopic radical surgery for rectal cancer.Methods A total of 89 patients underwent laparoscopic surgery for rectal cancer was divided into two groups of A（preserving left colon artery,46cases）and B（not preserving left colon artery,43cases）.The operative time,blood loss during surgery,the number of lymph nodes removed,ileostomy and postoperative complications were compared.The incidences of local reoccurrence and metastasis in two years after operation were observed.Results The operative time was longer in group A than that in group B[（187.10±41.37）min vs.（152.30±31.34）min]（P〈0.05）.The blood loss during surgery and the number of lymph nodes removed in group A were similar to those in group B（P〈0.05）.In group B,ileostomy was performed in 5cases,postoperative anastomotic leakage occurred in 3cases and anastomotic stenosis three months after surgery occurred in 7cases.There were no cases with ileostomy,postoperative anastomotic leakage and anastomotic stenosis in group A.In two years follow-up,group A had 3cases with anastomotic local recurrence and 4cases with liver metastasis,which were 4cases and 2cases in group B,respectively.Conclusion The preservation of left colon artery in laparoscopic radical surgery for rectal cancer can effectively preserve blood supply of proximal intestine,reduce the incidence of anastomotic stenosis.