保留左结肠动脉在腹腔镜直肠癌前切除术中的临床应用和疗效观察

Clinical application and curative effect of left colonic artery preservation in laparoscopic anterior resection of rectal cancer

目的探讨腹腔镜直肠癌前切除术中保留左结肠动脉(LCA)与否对临床疗效的影响。方法回顾分析2015年7月至2018年7月山西省肿瘤医院结直肠肛门外科收治的行腹腔镜直肠癌前切除术病例的临床资料,共186例,其中保留LCA组80例(观察组),不保留LCA组106例(对照组)。比较两组患者手术相关指标,包括手术时间、术中出血量、近端肠管缺血改变、淋巴结总清扫数量、第253组淋巴结清扫数量、预防性造口率、脾曲游离率、第253组淋巴结阳性转移率、排气时间、住院时间、术后并发症发生率(吻合口漏、吻合口出血、腹腔感染等)及术后随访结果。结果两组患者手术时间、术中出血量、淋巴结总清扫数量、第253组淋巴结清扫数量、预防性造口率、第253组淋巴结阳性转移率、住院时间、吻合口出血、腹腔感染、吻合口狭窄、尿潴留差异均无统计学意义(P>0.05)。近端肠管缺血改变情况(P=0.038)及脾曲游离率(P=0.038),观察组低于对照组;术后肛门首次排气时间,观察组低于对照组(t=6.935,P<0.05);术后吻合口漏发生率,观察组低于对照组,差异有统计学意义(χ^(2)=3.908,P=0.048)。术后所有患者均随访6~48个月,观察组局部复发率、远处转移率分别为2.5%(2/80)、11.3%(9/80),对照组分别为2.8%(3/106)、12.3%(13/106),差异均无统计学意义(P>0.05)。两组累积生存率比较,差异无统计学意义(P>0.05)。结论腹腔镜直肠癌前切除术中保留LCA在D3淋巴结清扫根治及远期疗效方面,可以达到与不保留LCA相同临床效果,且能明显保障吻合口血供,减少吻合口漏,促进术后肠道功能早期恢复,此术式是安全,可行的。

Objective To investigate the effect of preserving the left colonic artery (LCA) on the clinical efficacy of laparoscopic anterior resection of rectal cancer. Methods The clinical data of 186 patients who underwent laparoscopic anterior resection of rectal cancer in Shanxi Cancer Hospital from July 2015 to July 2018 were retrospectively analyzed, including 80 cases in the LCA preserving group (treatment group) and 106 cases in the non LCA preserving group (control group). The operation related indexes were compared between the two groups, including operation time, blood loss, changes of proximal intestinal ischemia, total number of lymph node dissection, and total number of the 253 group lymph node dissection, the rate of prophylactic stoma, separated spleen flexure, the positive rate of the 253 group lymph node metastasis, hospitalization duration, postoperative complications (anastomotic leakage, anastomotic bleeding, abdominal infection, etc.) and postoperative follow-up results. Results There was no significant difference between the two groups in terms of operation time, blood loss, total number of lymph node dissection, and total number of the 253 group lymph node dissection, the positive rate of the 253 group lymph node metastasis, exhaust time, hospitalization duration , anastomotic bleeding, abdominal infection, the stenosis of anastomosis and the retention of urine (P>0.05). The incidence of anastomotic leakage, The rate of prophylactic stoma (P=0.038), separated spleen flexure (P=0.038) were significantly lower in the treatment group than in the control group, the exhaust time were also lower in the treatment group (t=6.935, P<0.05), the incidence of anastomotic leakage were also lower in the treatment group(χ^(2)=3.908,P=0.048). All patients were followed up for 6~48 months. The local recurrence rate and distant metastasis rate in the treatment group were 2.5% and 11.3%, while those in the control group were 2.8% and 12.3%, with no statistical significance (P>0.05). There was no significant difference in cumulative survival rates between the two groups (P>0.05). Conclusion Preservation of LCA in laparoscopic anterior resection of rectal cancer in D3 lymph node dissection and long-term curative effect, can achieve the same clinical effect as non preservation of LCA, and can significantly protect the anastomotic blood supply, reduce anastomotic leakage, and promote the early recovery of intestinal function after operation. This operation is safe and feasible.