腹腔镜下低位前切除术中保留左结肠动脉对直肠癌患者疗效及预后的影响

Effect of Preserving the Left Colonic Artery during Laparoscopic Low Anterior Resection on the Outcome and Prognosis of Patients with Rectal Cancer

目的:探究腹腔镜下低位前切除术中保留左结肠动脉(LCA)对直肠癌患者的影响。方法:回顾性分析2018年4月至2021年2月到我院行腹腔镜直肠癌低位前切除术的85例患者的临床资料。根据治疗方式不同分为观察组(保留LCA,n=40例)和对照组(不保留LCA,n=45例)。比较两组手术相关指标及术后恢复情况;比较两组手术前后肠胃动力指标及肛门功能(Wexner便秘评分);比较两组随访12个月时的复发及转移情况,并记录术后并发情况。结果:观察组的手术时间较对照组明显延长(P<0.05),两组术中出血量、淋巴结总清扫数目、第253组淋巴结清扫数目、术中残端缺血性改变及预防性造口数比较差异无统计学意义(P>0.05);观察组的术后首次排气时间及住院时间显著短于对照组(P<0.05),两组进食流质时间比较差异无统计学意义(P>0.05);两组术后血清MTL、GAS水平较术前明显降低(P<0.05),Wexner便秘评分较术前明显升高(P<0.05),但两组上述指标治疗前后的差值比较差异均无统计学意义(P>0.05);随访12个月期间,观察组局部复发1例,肝脏转移2例,对照组局部复发3例,肝脏转移3例,两组复发及转移发生率比较差异无统计学意义(P>0.05);随访12个月期间,两组吻合口漏、吻合口出血、泌尿系统感染等并发症发生率比较差异无统计学意义(P>0.05)。结论:腹腔镜下低位前切除术中保留LCA,不影响胃肠功能及淋巴结清扫,且可缩短术后排气时间及住院时间,在复发转移方面与不保留LCA疗效相当。

Objective:To explore the effect of preserving the left colonic artery(LCA)during laparoscopic low anterior resection on patients with rectal cancer.Methods:The clinical data of 85 patients undergoing laparoscopic low anterior resection of rectal cancer in the hospital between April 2018 and February 2021 were retrospectively analyzed.According to different treatment methods,the patients were divided into the observation group(LCA preservation,n=40)and the control group(LCA non-preservation,n=45).The surgery-related indicators,postoperative recovery status,as well as gastrointestinal motility indicators,and anal function(Wexner constipation score)before and after surgery,were compared between the two groups.The recurrence and metastasis of the two groups were compared at 12 months of follow-up,and the postoperative complications were recorded.Results:The surgical time in the observation group was lengthened compared with that in the control group(P<0.05),and there were no statistical differences in the intraoperative blood loss,the total number of dissected lymph nodes,the number of dissected lymph nodes in group 253,ischemic changes of the stump during surgery and the number of prophylactic stomata between both groups(P>0.05).The postoperative first exhaust time and hospital stay were markedly shorter in the observation group compared to the control group(P<0.05),and there was no statistical significance in the fluid intake time(P>0.05).After surgery,the levels of serum MTL and GAS in the two groups were significantly reduced compared to before surgery(P<0.05)while the Wexner constipation score was significantly enhanced compared with before surgery(P<0.05),but there were no statistical significant differences in the changes of the above indicators before and after treatment between the two groups(P>0.05).During 12 months of follow-up,there was 1 case of local recurrence and 2 cases of liver metastasis in the observation group and 3 cases of local recurrence and 3 cases of liver metastasis in the control group,and the differences in the incidence rates of recurrence and metastasis were not statistically significant(P>0.05).During the 12-month follow-up,there were no statistical differences in the incidence rates of complications such as anastomotic leakage,anastomotic bleeding,and urinary tract infection between the two groups(P>0.05).Conclusion:LCA preservation during laparoscopic low anterior resection does not affect the gastrointestinal function and lymph node dissection and can shorten postoperative exhaust time and hospital stay,and it has the same efficacy in recurrence and metastasis as that without preservation of LCA.