保留左结肠动脉并留置肛管在直肠癌前切除术中的应用

Application of retention of the left colon artery and retention of the anal canal in the anterior resection of rectal cancer

目的 探讨保留左结肠动脉并留置肛管在直肠癌前切除术中的应用价值.方法 将行直肠癌前切除术的患者134例采用随机数字表法分为两组,观察组67例,行保留左结肠动脉并留置肛管的直肠癌前切除术;对照组67例行传统肠系膜下动脉根部结扎、不留置肛管的直肠癌前切除术.比较两组第253组淋巴结清扫数及术后吻合口瘘发生率,比较两组因吻合口瘘再手术率.结果 观察组、对照组第253组淋巴结清扫数分别为（4.2±1.3）个、（4.4±1.2）个,两组差异无统计学意义（P=0.450）.观察组吻合口瘘发生率为2.99％,对照组吻合口瘘发生率为11.94％,两组差异有统计学意义（χ2=3.890,P=0.049）.结论 在术前、术后围手术期管理无差异的情况下,直肠癌术中保留左结肠动脉并留置肛管,不影响第253组淋巴结清扫,但可为吻合口提供更充足的血运,减少发生吻合口瘘的危险因素.

Objective To explore the application of left colon artery and retention of anal canal in rectal cancer anterior resection .Methods 134 patients with rectal resection were divided into two groups by random number table.The observation group （n=67） received anterior resection of the left colonic artery and retained anorectal anterior resection.The control group（n=67） received subconjunctival artery root ligation ,non -retained anorectal anterior resection of rectal cancer .The number of lymph node dissection and the incidence of postoperative anastomotic leakage were compared between the two groups .The rate of reoperation was compared between the two groups .Results The number of lymph node dissection in the observation group and control group was （4.2 ±1.3）,（4.4 ±1.2）,the difference was not statistically significant （P=0.450）.The incidence rate of anastomotic leakage was 2.99％ in the observation group,which was 11.94％in the control group,the difference was statistically significant （χ2 =3.890,P=0.049）.Conclusion In the case of no difference in preoperative and postoperative perioperative management ,the left colonic artery and the anal canal were retained in the rectal cancer without affecting the lymph node dissection in No.253 group,but it could provide sufficient blood for the anastomosis ,to reduce the risk factor of the occurrence of anastomotic leakage .