腹腔镜直肠癌根治术中保留左结肠动脉的临床研究

Clinical study on left colonic artery preservation during laparoscopic radical resection of rectal cancer

目的:分析腹腔镜直肠癌根治术中保留左结肠动脉的必要性及临床应用价值。方法:回顾分析2018年1月1日至2019年6月30日收治的110例直肠癌患者的临床资料,根据是否保留左结肠动脉将其分为两组,观察组与对照组,两组患者年龄、体重指数、肿瘤长径及距肛缘距离、术后病理情况差异无统计学意义(P>0.05)。对比分析两组术中出血量、手术时间、预防性回肠造瘘情况、吻合口漏、脾区游离情况、术后肛门排气时间、253组淋巴结清扫数量及阳性率。结果:两组患者术后病理情况差异无统计学意义(P>0.05);对照组6例患者行结肠脾曲松解,占12.8%,使吻合口张力减小;观察组1例游离结肠脾区,两组差异有统计学意义(P<0.05)。对照组中6例行预防性末端回肠造瘘,占12.8%;观察组中1例行预防性末端回肠造瘘,两组差异有统计学意义(P<0.05)。对照组中8例术后出现吻合口漏,胆漏发生率17%;观察组中2例术后出现吻合口漏,发生率3.2%,两组相比差异有统计学意义(P<0.05)。两组出血量、手术时间、术后排气时间、253组淋巴结清扫数量及阳性率差异均无统计学意义(P>0.05)。结论:腹腔镜直肠癌根治术保留左结肠动脉不影响淋巴结的彻底清扫,不增加手术时间,同时可更好地保障吻合口的血液供应,减少术中游离脾区及回肠造瘘、吻合口漏的发生,在直肠癌根治术中具有一定优势。

Objective:To analyze the necessity and clinical value of left colonic artery reservation in laparoscopic radical resection of rectal cancer.Methods:The clinical data of 110 patients with rectal cancer from January 1,2018 to June 30,2019 were retrospectively analyzed.According to whether to reserve left colic artery,the 110 patients were divided into observation group and control group,respectively,there were no statistically significant differences in patient's age,BMI,tumor length,distance from anal edge to tumor or postoperative pathological conditions between two groups(P>0.05).The blood loss,operation time,prophylactic ileostomy fistula,anastomotic leakage,splenic area dissociation,postoperative anal exhaust time,number of lymph nodes dissected and positive rate of 253 group were compared and analyzed.Results:There was no statistically significant difference between the two groups in postoperative pathological conditions(P>0.05).In the control group,6 patients received splenic flexure of colon lysis,which reduced the anastomotic tension,the proportion was 12.8%.In the observation group,1 patient underwent splenic flexure of colon dissociation,and the difference between the two groups was statistically significant(P<0.05).6 patients in the control group underwent prophylactic terminal ileostomy,accounting for 12.8%.In the observation group,1 patient underwent prophylactic terminal ileostomy,and the difference between the two groups was statistically significant(P<0.05).There were 8 cases of anastomotic leakage in the control group,the incidence was 17%.There were 2 cases of anastomotic leakage in the observation group,which was 3.2%of the total patients,and there was a significant difference between the two groups(P<0.05).There was no statistically significant difference in terms of blood loss,operation time,postoperative exhaust time,number of 253 lymph node dissection and positive rate of 253 group(P>0.05).Conclusions:Laparoscopic radical resection of rectal cancer with preservation of the left colonic artery does not affect the complete dissection of lymph nodes,does not increase the operation time,and better protects the blood supply of anastomotic stoma,reduces the incidence of separation of splenic area,ileostomy and anastomotic leakage.Thus it has certain advantages in radical resection of rectal cancer.