保留左结肠动脉的腹腔镜直肠癌根治术在加速康复外科中的临床价值

The clinical value of preservation of left colon artery in laparoscopic radical resection for rectal cancer in the enhanced recovery after surgery

目的探讨保留左结肠动脉的腹腔镜直肠癌根治术在加速康复外科治疗模式中的临床价值。方法回顾性分析我科2014年1月至2017年12月收治的152例进入加速康复外科路径的直肠癌患者的临床资料,其中保留组(IMA非根部结扎,保留LCA)74例,不保留组(IMA根部结扎,不保留LCA)78例,比较两组患者术中情况、术后恢复情况、病理及吻合口并发症的发生。结果保留组与不保留组在年龄、性别、BMI、肿瘤大小、肿瘤距离肛缘距离、手术方式等一般资料比较差异均无统计学意义(P> 0.05),在术中出血、吻合口距齿状线距离、永久性造口、住院时间、排便失禁、术后病理结果、吻合口出血等方面差异均无统计学意义(P> 0.05)。保留组术后首次排气时间、第三站淋巴结清扫数、淋巴结清扫总数、吻合口漏发生率均低于不保留组,差异有统计学意义(P <0.05)。不保留组和保留组手术时间分别为(152.30±31.34)min和(171.10±41.37)min,两组差异有统计学意义(P <0.05)。结论保留左结肠动脉的腹腔镜直肠癌根治术降低了预防性造口率,减少了吻合口漏的发生,缩短了首次通气时间,在加速康复外科的临床实践中具有重要意义。

Objective To explore the clinical value of preservation of left colon artery in laparoscopic radical resection for rectal cancer in the mode of enhanced recovery after surgery(ERAS). Methods The clinical data of 152 rectal cancer patients admitted to ERAS from January 2014 to December 2017 were analyzed retrospectively.All the cases include 74 cases with preservation of LCA(low ligation of IMA)and 78 cases without preservation of LCA(high ligation of IMA). The intraoperative conditions,postoperative recovery,pathology and anastomotic complications were compared between the two groups. Results There was no significant difference in age,gender,BMI,tumor size,distance from tumor to anal margin and surgical approaches between the two groups. There was no significant difference in intraoperative bleeding,distance from anastomosis to dentate line,permanent stoma,hospital stay,defecation incontinence,postoperative pathological results and anastomotic bleeding(P > 0.05). The first ventilation time,number of D3 lymph node dissections and total lymph node dissections and anastomotic leakage rate in the low ligation group were lower than that in the high ligation group(P < 0.05). The operation time was(152.30 ± 31.34)min in the high ligation group,and(171.10 ± 41.37)min in the low ligation group,the difference between the two groups was statistically significant(P < 0.05). Conclusion Preservation of left colon artery in laparoscopic radical resection for rectal cancer can reduce the rate of prophylactic stoma and the incidence of anastomotic leakage,shorten the time of first ventilation,which is of great significance in the ERAS.