直肠癌腹腔镜低位前切除术中保留左结肠动脉的临床效果观察

Efficacy of preserving left colonic artery in laparoscopic lower anterior resection of rectal cancer

目的探讨直肠癌腹腔镜低位前切除术中保留左结肠动脉的临床效果。方法选择上海杨思医院普外科2018年4月至2019年4月收治的98例接受腹腔镜低位前切除术的低位直肠癌患者作为研究对象,以随机数字表法分为观察组与对照组,每组各49例。手术均由同一组医师完成,其中观察组术中保留左结肠动脉,对照组术中不保留左结肠动脉。比较两组围手术期指标(手术时间、术中出血量、淋巴结清扫总数、回肠造口率、游离脾曲率、住院时间)、胃肠功能恢复情况【术后首次肛门排气时间、手术前后胃泌素(GAS)、胃动素(MTL)水平变化情况】及术后并发症发生率、术后1年生存情况。结果两组手术时间、术中出血量、淋巴结清扫总数、回肠造口率、游离脾曲率比较差异均无统计学意义(均P>0.05),观察组住院时间短于对照组(P<0.05);手术前后两组胃肠功能各项指标比较差异均无统计学意义(均P>0.05),但两组术后GAS、MLT水平均低于术前(均P<0.05);两组并发症发生率比较差异均无统计学意义(均P>0.05);两组均行1年院外随访,生存率比较差异无统计学意义(P>0.05)。结论与不保留左结肠动脉相比,低位直肠癌患者腹腔镜低位前切除术中保留左结肠动脉术后恢复较快,可缩短患者住院时间,具有一定的临床意义。

Objectives To investigate the efficacy of preserving left colonic artery in laparoscopic lower anterior resection of rectal cancer.Methods Ninety-eight patients with low rectal cancer treated with laparoscopic lower anterior resection between April 2018 and April 2019 at Shanghai Yangsi Hospital were recruited and randomly assigned to treatment group and control group,with 49 patients in each group.A team of surgeons completed all surgeries.Left colonic artery was preserved in the treatment group and ligated in the control group.Duration of surgery,intraoperative blood loss,lymph node yield,ileostomy,splenic flexure mobilization,duration of hospitalization,recovery of gastrointestinal function(time to the first postoperative flatulence,and levels of gastrin and motilin before and after surgery),postoperative complications,and 1-year survival rate were compared between the two groups.Results The two groups did not differ significantly in surgery duration,intraoperative blood loss,lymph node yield,percentage of ileostomy,and percentage of splenic flexure mobilization(P>0.05).Duration of hospitalization was significantly shorter in the treatment group than in the control group(P<0.05).Levels of gastrin and motilin decreased after the surgery in both groups(P<0.05),but there was no significant difference in gastrointestinal function between the two groups before and after surgery(P>0.05).The risk of complications and the rate of 1-year survival were similar between the two groups(P>0.05).Conclusion Compared with ligation,preserving left colonic artery in laparoscopic lower anterior resection for low rectal cancer results in faster recovery and shorter hospitalization.It has a potential for broader use in clinical practice.