腹腔镜下中低位直肠癌根治术保留左结肠动脉的不同入路比较

Comparison of different approaches of left colon artery in laparoscopic radical resection of middle and low rectal cancer

目的探讨和比较腹腔镜下中低位直肠癌根治术保留左结肠动脉的不同入路。方法回顾性分析2016年1月至2020年1月接受腹腔镜下保留左结肠中低位直肠癌根治术患者73例。其中40例予以传统入路保留左结肠动脉,33例患者予以双侧入路保留左结肠动脉。本研究SPSS 23.0统计分析软件进行比较,术中术后指标等计量资料采用( x±s)表示,采用独立样本t检验;并发症发生率采用χ^(2)检验比较,P<0.05为差异有统计学意义。结果两组患者手术时间、术中出血量、吻合时间、淋巴结清扫总数、第三组淋巴结清扫总数,术后VSA评分、排气时间、肠道功能恢复时间、住院时间和术后2年复发率相比差异均无统计学意义(P>0.05)。双侧组患者治疗后吻合口漏、吻合口出血、肠管血运障碍、尿潴留、输尿管损伤等并发症发生率均明显低于对照组(P<0.05)。结论相较于传统入路,双侧入路腹腔镜下中低位直肠癌根治术保留左结肠动脉的疗效相近,但可显著降低手术后并发症发生率。

Objective To explore and compare the different approaches of preserving left colonic artery in laparoscopic radical resection of middle and low rectal cancer.Methods A total of 73 patients who received laparoscopic resection of middle and low left colon carcinoma from January 2016 to January 2020 were retrospectively reviewed.The left colic artery was preserved by traditional approach in 40 patients and bilateral approach in 33 patients.SPSS 23.0 statistical analysis software was used for comparison.Intraoperative postoperative indicators and other measurement data were expressed by(x±s)and independent sample T test was used.The incidence of complications was compared by χ^(2) test,P<0.05 was considered statistically significant.Results There were no significant differences in operation time,intraoperative blood loss,anastomotic time,total number of lymph node dissections,total number of lymph node dissections in the third group,postoperative VSA score,exsufflation time,recovery of bowel function,length of hospital stay recurrence rate of 2 years after surgery between the two groups(P>0.05).the incidence of complications such as anastomotic leakage,anastomotic bleeding,intestinal blood obstruction,urinary retention and ureter injury in bilateral group was significandy lower than that in control group(P<0.05).Conclusion Compared with the traditional approach,bilateral approach laparoscopic radical resection of middle and low rectal cancer with preservation of left colon artery has similar curative effect,but can significantly reduce the incidence of postoperative complications.