腹腔镜直肠癌根治术中保留左结肠动脉对肠系膜下动脉3型直肠癌病人临床疗效及术后并发症的影响

Analysis of the efficacy of LCA in patients with IMA3 rectal cancer and the risk factors of postoperative anastomotic leakage during laparoscopic radical resection of rectal cancer

目的探讨腹腔镜直肠癌根治术中保留左结肠动脉(left colic artery, LCA)对肠系膜下动脉(inferior mesenteric artery,IMA)3型直肠癌病人疗效及术后吻合口漏的危险因素。方法 IMA3型直肠癌病人102例,根据手术治疗方式的不同分为分为研究组和对照组,研究组52例,采用腹腔镜直肠癌根治术中保留LCA治疗,对照组50例,采用腹腔镜直肠癌根治术中不保留LCA治疗,比较2组病人的临床疗效。结果研究组和对照组手术时间分别为(149.2±25.2)分钟和(145.8±22.5)分钟,住院时间分别为(11.8±2.4)天和(12.2±2.8)天,淋巴结清扫数目分别为(14.6±2.5)枚和(14.8±2.6)枚,IMA根部淋巴结清扫数分别为(3.2±1.3)枚和(3.0±1.5)枚,1年总生存率分别为88.1%和83.3%,复发或转移率分别为14.3%和11.9%,两组比较差异均无统计学意义(P> 0.05),肛门排气时间分别为(35.6±5.4)小时和(45.3±8.6)小时,术后吻合口漏发生率分别为1.9%和14.0%,两组比较差异有统计学意义(P<0.05),肠梗阻、尿潴留和泌尿系感染发生率分别为9.6%和12.0%、1.9%和4.0%、5.8%和8.0%,两组比较差异无统计学意义(P>0.05);术前生活质量分别为(56.2±9.2)分和(56.5±10.5)分,术后分别为(78.8±12.2)分和(78.4±12.0)分,两组比较差异均无统计学意义(P> 0.05)。结论在保证临床安全及疗效的情况下,腹腔镜直肠癌根治术中保留LCA可有效降低IMA3型病人术后吻合口漏的发生率。

Objective To explore the left colic artery(LCA)during laparoscopic radical resection of rectal cancer Efficacy and risk factors of postoperative anastomotic leakage in patients with inferior mesenteric artery(IMA)type 3 rectal cancer.Methods 102 patients with IMA3 rectal cancer were divided into the study group(52 cases)and the control group(50 cases)according to different surgical treatment methods.The study group was treated with LCA in laparoscopic radical resection of rectal cancer,while the control group was treated with LCA without laparoscopic radical resection of rectal cancer,and the clinical efficacy of the two groups was compared.Results The operation time of the study group and the control group were(149.2±25.)minutes and(145.8±22.5)minutes,and the hospitalization time was(11.8±2.4)days and(12.2±2.8)days,respectively.The number of lymph node dissections was(14.6±2.5)The sum of(14.8±2.6)pieces of IMA root lymph node dissection was(3.2±1.3)and(3.0±1.5),respectively.The 1-year overall survival rate was 88.1% and 83.3%,respectively.The recurrence or metastasis rate were respectively.For 14.3% and 11.9%,there was no significant difference between the two groups(P>0.05),and the anal exhaust time was(35.6±5.4)hours and(45.3±8.6)hours,respectively.The incidence of postoperative anastomotic leakage was 1.9% and 14.0%,respectively.The difference between the two groups was statistically significant(P<0.05).The incidence of intestinal obstruction,urinary retention and urinary tract infection were 9.6% and 12.0%,1.9% and 4.0%,5.8% and 8.0%,respectively.Preoperative life quality was(56.2±9.2)and(56.5±10.5),and postoperative life qualitywas(78.8±12.2)and(78.4±12.0),respectively,with no statistically significant difference between the two groups(P>0.05).Conclusions In the case of clinical safety and efficacy,the retention of LCA in laparoscopic radical resection of the rectum can effectively reduce the incidence of postoperative anastomotic leakage in patients with IMA3.Therefore,in the future clinical work,these patients should be paid attention to.