头侧中间联合入路腹腔镜直肠癌根治术中保留左结肠动脉的临床研究

A clinical study on the preservation of left colon artery during cephalic middle combined approach laparoscopic radical resection of rectal cancer

目的探讨头侧中间联合入路腹腔镜直肠癌根治术(LRR)中保留左结肠动脉(LCA)的临床疗效。方法前瞻性分析2015年6月至2017年6月收治的行头侧中间联合入路LRR患者90例,根据不同LCA处理方式采用随机数字表法将患者分为未保留LCA组(未保留组)和保留LCA组(保留组),各45例。采用SPSS 22.0统计学软件对数据进行分析,围术期各项指标等计量资料采用(±s)表示,独立t检验;并发症发生率采用χ^(2)检验或Fisher精确检验;生存分析采用Kaplan-Meier法并行Log-rank检验。P<0.05表示差异有统计学意义。结果保留组患者手术时间、术后排气时间优于未保留LCA组比较(P<0.05);保留组与未保留组患者术后吻合口漏发生率(2.2%,17.8%)及并发症总发生率(6.7%,26.7%)比较,差异均有统计学意义(P<0.05);3年随访生存分析,未保留组患者3年总生存率(OS)为73.3%,无病生存率(DFS)为66.7%;保留组患者3年OS为77.8%,DFS为68.9%,两组患者OS与DFS比较差异无统计学意义(P=0.464、0.821)。结论头侧中间联合入路腹腔镜直肠癌根治术中保留LCA利于患者术后恢复,可完成与不保留LCA相似的淋巴清扫数量,可改善吻合口血供,降低并发症的发生率。

Objective To investigate the clinical effect of left colonic artery(LCA)preservation in laparoscopic radical resection of rectal cancer(LRR)by cephalic median combined approach.Methods A prospective analysis of 90 patients with LRR using cephalic intermediate combined approach admitted from June 2015 to June 2017 was conducted.According to the different treatment methods of LCA,the patients were divided into two groups by random number table,45 patients in each group,including unreserved LCA group and reserved LCA group.SPSS 22.0 statistical software was used to analyze the data.Perioperative indicators and other measurement data were represented by and independent t test.The incidence of complications was determined byχ^(2) test or Fisher’s exact test.Kaplan-Meier parallel log-rank test was used for survival analysis.P<0.05 indicated statistically significant difference.Results The operation time and postoperative exhaust time in the retention group were better than those in the non-retention LCA group(P<0.05).There were statistically significant differences in the incidence of postoperative anastomotic leakage(2.2%,17.8%)and the total incidence of complications(6.7%,26.7%)between the retention group and the non-retention group(P<0.05).The 3-year overall survival(OS)and disease-free survival(DFS)were 73.3%and 66.7%in the unretained group.The 3-year OS and DFS of the retention group were 77.8%and 68.9%,respectively.There was no significant difference in OS and DFS between the two groups(P=0.464,0.821).Conclusion The retention of LCA in laparoscopic radical resection of rectal cancer through cephalic intermediate combined approach is beneficial to the postoperative recovery of patients,which can improve the anastomotic blood supply and reduce the incidence of complications.