血管三维重建技术在腹腔镜保留左结肠动脉的直肠癌低位前切除术的临床应用研究

Clinical study of vascular three-dimensional reconstruction in the laparoscopic surgery for rectal cancer with preservation of the left colic artery

目的探讨术前血管三维重建技术在保留左结肠动脉(LCA)的腹腔镜直肠癌低位前切除术中的临床应用价值。方法采用回顾性队列研究的方法,分析中国医学科学院肿瘤医院结直肠外科2019年1月至8月行保留LCA的腹腔镜直肠癌低位前切除术的146例患者临床资料。所有病例均行保留LCA的腹腔镜直肠癌低位前切除术,术中及术后数据资料完整。根据术前是否行血管三维重建,分为重建组(72例)和非重建组(74例)。收集并比较分析两组患者临床特征、手术情况、并发症、病理结果以及术后恢复情况等。结果研究共纳入符合入组条件的直肠癌患者146例,其中重建组72例,非重建组74例。重建组男性47例,女性25例,年龄(59.75±6.2)岁,体质指数(24.1±2.2)kg/m^(2),非重建组男性51例,女性23例,年龄(58.77±6.1)岁,体质指数(23.6±2.7)kg/m^(2),两组患者基线资料的比较,差异均无统计学意义(P>0.05)。肠系膜下动脉分型重建组I型35例,Ⅱ型25例,Ⅲ型11例,Ⅳ型1例;非重建组I型37例,Ⅱ型24例,Ⅲ型12例,Ⅳ型1例,两组动脉分型比较,差异无统计学意义(P>0.05)。手术时间重建组(162.2±10.8)min,非重建组(197.9±19.1)min,两组比较重建组手术时间缩短,差异有统计学意义(t=-13.840,P<0.05)。术中出血量重建组(30.4±20.0)m L,非重建组(61.2±26.4)mL,重建组出血量较少,差异有统计学意义(t=-7.930,P<0.05)。重建组和非重建组在吻合口漏(1.4%vs.1.4%,P=0.984)、吻合口出血(2.8%vs.4.1%,P=0.672)、术后住院时间(6.8±0.7 d vs.7.0±0.7 d,P=0.141)和术后病理方面差异均无统计学意义(P>0.05)。结论术前血管三维重建技术可以缩短手术时间,减少术中出血量,建议行术前血管三维重建,为腹腔镜保留LCA的低位前切除术提供术中参考。

Objective To investigate the clinical application of vascular three-dimensional reconstruction in laparoscopic low anterior resection for rectal cancer with preservation of left colic artery(LCA).Methods A retrospective cohort study was carried out.Clinical data of 146 patients undergoing laparoscopic rectal cancer surgery with preservation of the LCA in the Cancer Hospital Chinese Academy of Medical Sciences from January 2019 to August 2019 were retrospectively analyzed.All the patients weretreated with laparoscopic rectal cancer surgery with preservation of the LCA and had complete operative and postoperative data.Based on the vascular reconstruction or not,seventy-two patients received vascular threedimensional reconstruction(reconstruction group)and 74 patients did not receive reconstruction(nonreconstruction group).Patient demographics,operative data,postoperative complications,pathological data and postoperative recovery data were compared between the two groups.Results A total of 146 patients with rectal cancer eligible for enrollment were included in the study,of which 72 were in the reconstruction group and 74 were in the non-reconstruction group.In the reconstruction group,there were 47 males and 25 females,mean age was(59.75±6.2)years old,mean body mass index was(24.1±2.2)kg/m^(2).In the nonreconstruction group,there were 51 males and 23 females,mean age was(58.77±6.1)years old,mean body mass index was(23.6±2.7)kg/m~2.There was no statistically significant difference in the baseline data between the two groups(P>0.05).In terms of vascular type of IMA,there were 35 cases for type I,25 cases for typeⅡ,11 cases for typeⅢand 1 case for typeⅣin the reconstruction group and 37 cases for type I,24 cases for typeⅡ,12 cases for typeⅢand 1 case for typeⅣin the non-reconstruction group.There was no statistically significant difference in the vascular type between the two groups(P>0.05).The operation time was(162.2±10.8)min in the reconstruction group and(197.9±19.1)min in the non-reconstruction group.Compared with the non-reconstruction group,the operation time was shortened in the reconstruction group,and the difference was statistically significant(t=-13.840,P<0.05).Intraoperative blood loss was(30.4±20.0)m L in the reconstruction group and(61.2±26.4)m L in the non-reconstruction group.The blood loss in the reconstruction group was less,and the difference was statistically significant(t=-7.930,P<0.05).There were no statistically significant differences between the reconstruction group and non-reconstruction group,with regard to anastomotic leakage(1 case,1.4%vs.1 case,1.4%,P=0.984),anastomotic bleeding(2 cases,2.8%vs.3 cases,4.1%,P=0.672),postoperative hospitalization(6.8±0.7 d vs.7.0±0.7 d,P=0.141)and postoperative pathological outcomes(P>0.05).Conclusions Our study suggested that preoperative vascular three-dimensional reconstruction can reduce the operative time and blood loss in laparoscopic rectal cancer surgery with preservation of the LCA.Preoperative vascular three-dimensional reconstruction,which can provide reference for the operation,is therefore recommended for laparoscopic rectal cancer surgery with LCA preservation in rectal cancer surgery.