保留左结肠动脉的腹腔镜直肠癌根治21例预后

Prognosis of 21 cases of laparoscopic radical treatment of rectal cancer with left colon artery preserved

目的探讨腹腔镜直肠癌根治术中保留左结肠动脉对病人预后的临床研究。方法回顾性分析六安市中医院2015年1月1日至2017年12月31日40例腹腔镜直肠癌根治术的临床病例资料,其中保留左结肠动脉21例,高位结扎肠系膜下动脉19例,比较两组围手术期及近期预后的情况。结果两组手术时间、出血量、术后排气时间、第3站淋巴结清扫数目、肿瘤下切缘距离、术后吻合口瘘、术后住院时间均差异无统计学意义(P>0.05);高位结扎肠系膜下动脉组术中结肠残端缺血需游离脾曲的比率是31.6%(6/19),保留左结肠动脉组无需游离脾曲(0/21),差异有统计学意义(P<0.05)。两组术后随访15~50个月,两组术后总体生存率、无病生存率均差异无统计学意义(P>0.05)。结论腹腔镜直肠癌根治术中保留左结肠动脉在保证第3站淋巴结清扫及不增加病人复发率及转移率的基础上,可以有效地保证吻合口血供及游离脾曲的概率,有临床应用价值。

Objective To explore the effect of laparoscopic radical rectal surgery with left colonic artery(LCA)preservation on the prognosis of patients.Methods40 patients of laparoscopic radical resection of rectal cancer from January 2015 to December 2017,were received by Lu’an hospital of traditional Chinese medicine,including 21 cases with preservation of LCA and 19 cases with high ligation of inferior mesenteric artery.The perioperative period and short-term outcome data of the two groups were collected and compared and analyzed retrospectively.ResultsThere were no differences in surgical time,blood loss,postoperative exhaust time,the number of D3 lymph nodes,tumor margin distance,anastomotic leakage and postoperative hospital stays between the two groups(P>0.05);the rate of free splenic melody was 31.6%(6/19)in the group without preservation of left colic artery,and which didn’t occur in the group with preservation of left colic artery(0/21),the difference was statistically significant(P<0.05).The two groups were followed up for 15-50 months,there was no significant difference in the overall survival rates and disease-free survival rates between the two groups(P>0.05).ConclusionLaparoscopic radical rectal surgery with with preservation of the LCA can effectively ensure the blood supply of proximal and radical dissection of D3 lymph nodes,which is worth of clinical promotion.