腹腔镜直肠癌前切除术中左结肠动脉的处理方式对患者术后并发症的影响

The effect of surgical management of left colic artery in laparoscopic anterior resection of rectal cancer on the incidence of postoperative complications

目的探究腹腔镜下直肠癌前切除术中左结肠动脉(LCA)的两种不同处理方式对患者术后并发症的影响。方法根据LCA处理方式的不同将150例行腹腔镜直肠癌前切除术的患者分为保留LCA组(n=85)和不保留LCA组(n=65)。对两组患者的手术相关指标及术后并发症发生情况进行比较。结果两组患者的术中出血量、手术时间、淋巴结清扫数目、253组淋巴结阳性例数比较,差异均无统计学意义(P﹥0.05);保留LCA组患者的术后首次排气时间明显短于不保留LCA组(P﹤0.01);保留LCA组患者的结肠造瘘率、吻合口瘘发生率均低于不保留LCA组(P﹤0.05)。结论腹腔镜直肠癌前切除术中保留LCA能保证结肠残端及吻合口的血供,降低末端结肠造瘘的发生率,缩短术后首次排气时间并降低术后吻合口瘘的发生风险。

Objective To compare the effects of two different management methods of left colic artery (LCA) in laparoscopic anterior resection of rectal cancer on the incidence of complications among patients with rectal cancer. Method 150 patients treated with laparoscopic anterior resection for rectal cancer were assigned as preserved LCA group (n=85) and non- preserved LCA group (n=65), respectively. Surgical indicators and incidence of postoperative complications were compared between the two groups. Result There was no significant difference between the two groups in terms of volume of intraoperative blood loss, operative time, number of lymph node dissected and number of positive lymph nodes in 253 groups (P>0.05). The first flatus time in preserved LCA group was significantly shorter than that in non-preserved LCA group (P<0.01);the incidence of sigmoid colostomy and anastomotic leakage in preserved LCA group were all lower compared to non-preserved LCA group respectively (P<0.05). Conclusion In the laparoscopic anterior resection of rectal cancer, the preservation of LCA can ensure the blood supply for proximal intestine, reducing the incidence of anastomotic leakage and sigmoid colostomy, with less time to first flatus.