腹腔镜下直肠前切除术中保留左结肠动脉对促进患者术后的康复作用

Enhanced recovery after preserving the left colonic artery during laparoscopic anterior resection for rectal cancer

目的探讨腹腔镜下直肠前切除术中保留左结肠动脉能否促进患者术后的快速康复作用。方法回顾性分析我院91例(术后临床分期均为Ⅱ期)行腹腔镜下直肠前切除术患者的临床资料,将保留左结肠动脉的腹腔镜下直肠前切除术患者作为观察组(40例),不保留左结肠动脉的腹腔镜下直肠前切除术患者作为对照组(51例),比较两组间的手术时间、术中出血量、术后排气排便时间、术后腹胀、腹痛不适时间、术后住院时间、肠系膜根部淋巴结清扫数以及预防性回肠造口和吻合口瘘的发生情况、住院费用。结果 91例患者均顺利完成手术,术中无中转开腹手术病例,术中无直肠破裂穿孔,无血管、输尿管及邻近器官损伤,吻合口无张力。两组患者手术时间、术中出血量及肠系膜根部淋巴结清扫数差异无统计学意义(P>0.05),因低位直肠癌行末端回肠预防性造口,观察组有3例,对照组有5例;观察组术后40例患者全部无发生吻合口瘘,对照组术后有3例患者发生吻合口瘘;术后自觉明显腹胀、腹痛不适持续时间,观察组为2.14±0.35 d,对照组为3.15±0.42 d;术后排气时间,观察组平均为37.15±12.62 h,对照组为62.25±11.75 h;术后排便时间,观察组为3.16±0.52 d,对照组为4.25±0.75 d;术后住院时间,观察组为4.54±0.42 d,对照组为6.23±0.51 d;手术住院期间的总体费用,观察组为34 525.32±1206.36元,对照组为41 215±1051.32元。患者术后发生腹痛持续时间、术后住院时间、手术住院期间的总体费用,两组比较具有统计学差异(P<0.05)。结论腹腔镜下直肠前切除术中保留左结肠动脉能有效保证降结肠和吻合口的血供,减少手术后并发症,缩短术后住院日,减少手术住院期间的总体费用。

Objective To evaluate the postoperative outcomes of preserving the left colonic artery during laparoscopic anterior resection for rectal cancer.Methods The clinicopathologic data of 91 rectal cancer patients （pathologic Stage II） undergoing laparoscopic anterior resection was retrospectively analyzed.During the surgeries,the left colonic artery was preserved in 40 patients （preserved group） and ligated in 51 patients （unpreserved group）.The operating time,intraoperative blood loss,time to first flatus and defecation,duration of postoperative abdominal distension and pain,number of retrieved lymph nodes,ileum fistulation and anatomical leakage rate were compared between the two groups.Results The surgeries were completed in all the 91 patients laparoscopically without conversion.There was no intraoperative complications including rectal perforation,injury to vessel or ureter in either group.The operating time,blood loss and number of retrieved lymph nodes were similar between the groups （P〈0.05）.Three patients in preserved group and 5 in ligation group received preventive ileum fistulation due to low rectal cancer.Anatomical leakage occurred in three patients of unpreserved group.The average duration of postoperative abdominal distension and pain was 2.14±0.35 days in preserved group and 3.15±0.42 days in ligation group.The time to first flatus and defecation was 37.15±12.62 h and 3.16±0.52 days in preserved group and 62.25±11.75 h and 4.25±0.75 days in ligation group.Postoperative hospital stay was 4.54±0.42 days in preserved group and 6.23±0.51 days in ligation group.Total hospitalization cost in the two groups was 34 525.32 ± 1206.36 Yuan and 41 215 ± 1051.32 Yuan,respectively.Significant differences were found the in duration of postoperative abdominal distension and pain,postoperative hospital stay,and total cost between the two groups （P〈0.05）.Conclusion During laparoscopic anterior resection for rectal cancer,preserving the left colonic artery effectively ensures the blood supply to the anastomosis and the remaining descending colon to promote the recovery of the patients after surgery.