腹腔镜辅助低位直肠癌前切术中保留左结肠动脉的临床研究

Clinical Study on Preservation of left colonic Artery in laparoscopicassisted anterior Resection of low rectal Cancer

目的探讨腹腔镜辅助低位直肠癌前切术(Dixon)中保留左结肠动脉的临床疗效及并发症情况。方法回顾性分析2016年1月至2019年8月河南理工大学第一附属医院普外科收治的131例低位直肠癌患者的临床资料,按照术中肠系膜下动脉处理方式不同分为不保留左结肠动脉的高位结扎组(73例)与保留左侧结肠动脉的低位结扎组(58例),对比两组患者的手术情况、术后并发症情况。结果低位结扎组手术时间较高位结扎组长,术后住院天数较高位结扎组短,游离脾区例数较高位结扎组少,两组差异有统计学意义(P<0.05);两组患者在术中出血量、肠管远切缘长度、术后排气时间、淋巴结清扫数及IMA淋巴结清扫数差异无统计学意义(P>0.05)。两组患者在总并发症发生率、切口感染、肠梗阻、术后排尿及性功能障碍方面差异无统计学意义(P>0.05);但低位结扎组患者在吻合口出血、吻合口瘘、缺血性肠炎的发生率较高位结扎组低,差异有统计学意义(P<0.05)。结论腹腔镜辅助低位直肠癌前切术中保留左结肠动脉安全可行,可以降低术后吻合口瘘、吻合口出血、缺血性肠炎的发生率。

Objective To investigate the clinical effect and complications of preserving left colonic artery in laparoscopicassisted anterior resection(Dixon)of low rectal cancer.Methods From January 2016 to August 2019,the clinical data of 131 patients with low rectal cancer admitted to the General Surgery Department of the First Affiliated Hospital of Henan University of Technology were analyzed retrospectively,the patients were divided into high ligation group(73 cases)and low ligation group(58 cases)without preservation of the left colonic artery according to the way of inferior mesenteric artery treatment during operation,the operative conditions and postoperative complications were compared between the two groups.Results The operation time of the low ligation group was longer than that of the high ligation group,the hospitalization days were shorter than that of the high ligation group,and the number of cases of free spleen area was less than that of the high ligation group.There was no significant difference between the two groups in the amount of bleeding,the length of distal margin,the time of postoperative ventilation,lymph node clearance and IMA lymph node clearance(P>0.05).There was no significant difference in total complication rate,wound infection,intestinal obstruction,postoperative urination and sexual dysfunction between the two groups(P>0.05).However,the incidence of anastomotic bleeding,anastomotic fistula and ischemic enteritis in low ligation group was lower than that in high ligation group(P<0.05).Conclusion It is safe and feasible to preserve the left colon artery in laparoscopic-assisted anterior resection of low rectal cancer,which can reduce the incidence of anastomotic leakage,anastomotic bleeding and ischemic enteritis.