保留肠系膜下动脉血管鞘在腹腔镜直肠癌根治术中的有效性和安全性分析

Analysis of effectiveness and safety of preserving vascular sheath of inferior mesenteric artery in laparoscopic radical operation for rectal cancer

目的探讨保留肠系膜下动脉(inferior mesenteric artery,IMA)血管鞘清扫253淋巴结在腹腔镜下直肠癌根治术中的有效性和安全性。方法回顾性分析了皖南医学院第一附属医院胃肠外科2018年9月至2020年8月期间行腹腔镜直肠癌根治术治疗患者的临床资料,共计115例。将行术中打开IMA血管鞘患者(68例)设为对照组,行保留IMA血管鞘患者(47例)设为保留组;比较两组手术时间、253淋巴结清扫时间、术中出血量、术中输血量、淋巴结的清扫总数、253淋巴结总数及阳性数、吻合口漏、术后住院时间、术后首次通气时间、肺部感染、术后肠梗阻、切口感染、尿路感染及乳糜漏等指标。结果与对照组相比,保留组253淋巴结清扫时间短、手术时间短、术中出血量少、术后首次通气时间更早,差异均有统计学意义(P<0.01或P<0.05)。两组在淋巴结清扫总数、253淋巴结清扫总数、253淋巴结阳性数术中输血、吻合口漏、术后住院时间、术后肺部感染、术后肠梗阻、切口感染、尿路感染及术后乳糜漏差异无统计学意义(P>0.05)。结论腹腔镜直肠癌根治术中保留IMA血管鞘清扫253组淋巴结,能够缩短手术时间,降低术中出血量,提高术后首次通气时间,降低手术风险,在围手术期具有良好的有效性和安全性。

Objective To investigate the effectiveness and safety of preserving vascular sheath of inferior mesenteric artery(IMA)and dissection of No.253 lymph nodes in laparoscopic radical operation for rectal cancer.Methods This study retrospectively analyzed the clinical data of 115 patients who underwent laparoscopic radical operation for rectal cancer at the Department of Gastrointestinal Surgery,the First Affiliated Hospital of Wannan Medical College from September 2018 to August 2020.68 patients with opening IMA vascular sheath during operation were set as control group,and 47 patients with preserving IMA vascular sheath were set as preservation group.This study compred the indexes of these two groups,including the operation time,the time of dissecting No.253 lymph nodes,intraoperative blood loss volume,intraoperative blood transfusion volume,total number of dissected lymph nodes,total number of No.253 lymph nodes,number of positive No.253 lymph nodes,anastomotic leakage,postoperative hospital stay,first ventilation time after operation,pulmonary infection,postoperative intestinal obstruction,incision infection,urinary tract infection and chylous leakage.Results Compared with the control group,the preservation group had shorter time for dissecting No.253 lymph nodes,shorter operation time,less intraoperative blood loss and earlier first ventilation time.These differences were statistically significant(P<0.01 or P<0.05).The two groups had no significant difference in the total number of dissected lymph nodes,total number of dissected No.253 lymph nodes,number of positive No.253 lymph nodes,intraoperative blood transfusion,anastomotic leakage,postoperative hospital stay,postoperative pulmonary infection,postoperative intestinal obstruction,incision infection,urinary tract infection and chylous leakage(P>0.05).Conclusion Preservation of IMA vascular sheath of IMA and dissection of No.253 lymph nodes in laparoscopic radical operation for rectal cancer can shorten the operative time,reduce the amount intraoperative blood loss,increase the first ventilation time after operation and decrease the operative risk,with satisfactory effectiveness and safety in perioperative period.