摘要
目的探讨保留左结肠动脉(LCA)并行第253组淋巴结清扫对腹腔镜直肠癌根治术手术安全性和疗效的影响。方法选取2017年4月—2021年2月六安市人民医院结直肠外科80例腹腔镜直肠癌根治术患者,按随机数字表法分为观察组和对照组各40例。观察组给予保留LCA,并清扫第253组淋巴结。对照组不保留LCA,于肠系膜下动脉根部离断。比较2组术中、术后情况。结果术中情况:观察组和对照组吻合口上端结肠边缘动脉弓压力分别为(47.00±9.02)mm Hg(1 mm Hg=0.133 kPa)、(37.40±7.52)mm Hg,组间差异有统计学意义(P<0.05);观察组术中暂时夹闭LCA,结肠边缘动脉弓压力为(36.00±8.37)mm Hg,与夹闭前差异有统计学意义(P<0.05),与对照组比较差异无统计学意义(P>0.05);2组手术时间、术中出血量、253组淋巴结清扫数、肠系膜淋巴结清扫数比较差异均无统计学意义(均P>0.05);2组游离脾曲率、预防性造口率比较差异有统计学意义(均P<0.05)。术后情况:2组术后吻合口漏发生率、首次肛门排气时间比较差异有统计学意义(均P<0.05)。结论保留LCA并行第253组淋巴结清扫可保证清扫彻底,并发症发生率未增加;明显提高吻合口近端结肠边缘动脉弓压力,降低预防回肠造口率、脾曲游离率,降低术后吻合口漏发生率,是一种安全可靠的术式。
Objective To evaluate the safety and efficacy of laparoscopic radical resection of rectal cancer with left colonic artery(LCA)preservation and group 253(253rd group)lymph node dissection.Methods From April 2017 to February 2021,80 patients who underwent laparoscopic radical resection of rectal cancer in the Colorectal Surgery Department of Lu'an People's Hospital were selected and randomly divided into the observation group and control group(40 cases in each group).The observation group was given LCA preservation,and the 253rd group lymph nodes were cleaned.In the control group,LCA was not retained,but the inferior mesenteric artery was severed.The intraoperative and postoperative conditions of both groups were compared.Results Intraoperative conditions:the pressures of colonic marginal artery arch in the observation group and the control group were(47.00±9.02)mm Hg(1 mm Hg=0.133 kPa)and(37.40±7.52)mm Hg,respectively.The difference between the two groups was statistically significant(P<0.05).In the observation group,LCA was temporarily clamped during operation,and the pressure of colonic marginal artery arch was(36.00±8.37)mm Hg.The difference before and after clipping was statistically significant(P<0.05),but there was no significant difference between the two groups(P>0.05).There was no significant difference in operation time,intraoperative blood loss,number of lymph nodes removed in 253rd group lymph node dissection and mesenteric lymph node dissection between the two groups(all P>0.05).There was significant difference in free spleen curvature and preventive stoma rate between the two groups(all P<0.05).Postoperative situation:there were significant differences in the incidence of anastomotic leakage and the first anal exhaust time between the two groups(all P<0.05).Conclusion Preserving LCA and 253rd group lymph node dissection can ensure thorough dissection without increasing complications,significantly increase the pressure of proximal colonic artery arch,reduce the rate of ileostomy prevention and splenic flexure dissociation,and reduce the incidence of postoperative anastomotic leakage.It is a safe and reliable operation.
作者
王永森
谢贻祥
王传思
黄宏武
葛思堂
WANG Yong-sen;XIE Yi-xiang;WANG Chuan-si;HUANG Hong-wu;GE Si-tang(Department of Colorectal Surgery,Lu'an Hospital Affiliated to Anhui Medical University,Lu'an,Anhui 237005,China;不详)
出处
《中华全科医学》
2022年第3期366-370,共5页
Chinese Journal of General Practice
基金
安徽高校自然科学研究项目(KJ2020A0550)。
关键词
直肠癌
左结肠动脉
第253组淋巴结
边缘弓动脉压
腹腔镜下直肠癌根治术
吻合口瘘
游离脾曲
Rectal cancer
Left hemicolonic artery
Group 253 lymph nodes
Arterial pressure of marginal arch
Laparoscopic radical resection of rectal cancer
Anastomotic leakage
Free splenic flexure