保留左结肠-乙状结肠动脉弓在中低位直肠癌根治术中的应用体会

Application of Preserving Left Colon-sigmoid Artery Arch in Radical Resection of Middle and Low Rectal Cancer

目的:探讨在中低位直肠癌根治术中,保留左结肠-乙状结肠动脉弓对吻合口血供和张力的影响及应用价值。方法:回顾性分析安徽医科大学第二附属医院2019年1月-2021年5月行腹腔镜中低位直肠癌根治术60例患者的临床资料,保留(研究组)和不保留左结肠-乙状结肠动脉弓(对照组)患者各30例。记录术中肠管断端血供、肠系膜根部淋巴结数目、保留乙状结肠肠管长度、淋巴结清扫时间、手术时间和出血量,以及术后并发症情况。结果:60例患者均顺利完成手术,无围手术期死亡病例。研究组结肠断端血供良好率高于对照组(P<0.05),对照组有4例患者肠管预切线处血供不佳,需进一步游离结肠脾区。研究组乙状结肠剩余长度明显长于对照组(P<0.05)。研究组淋巴结清扫时间长于对照组,差异有统计学意义(P<0.05)。肠系膜下动静脉根部淋巴结清扫数目、手术时间和术中出血量,两组差异均无统计学意义(P>0.05)。术后并发症研究组5例,对照组6例,两组差异无统计学意义(P>0.05)。研究组无吻合口漏,对照组吻合口漏1例。结论:中低位直肠癌根治术中保留左结肠-乙状结肠动脉弓,未明显增加手术时间和术后并发症的发生,肿瘤根治效果与传统手术相似。该术式通过增加吻合口近端肠管的长度可以减少吻合口张力,同时改善吻合口血供,可能有利于降低吻合口漏的发生,近期疗效较好。

Objective:To investigate the effect of preserving left colon-sigmoid artery arch on anastomotic blood supply and tension in radical resection of middle and low rectal cancer.Method:The clinical data of 60patients who underwent laparoscopic middle and low radical resection of rectal cancer from January 2019 to May 2021in the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed.There were 30 patients in each group with or without preservation of left sigmoid artery arch(the research group or the control group).Blood supply of the broken end of the intestine,the number of mesenteric lymph nodes,retention of sigmoid colon,lymph node dissection time,operation time,bleeding volume and postoperative complications were recorded.Result:Sixty patients were successfully completed the operation,no perioperative death.The good blood supply rate of colon stump in the research group was higher than that in the control group(P<0.05).In the control group,there were 4 patients with poor blood supply at the pre tangent line of the intestinal tract,which required further dissociation of the splenic region of colon.The remaining length of sigmoid colon in the research group was significantly longer than that in the control group(P<0.05).The time of lymph node dissection in the research group was longer than that in the control group(P<0.05).There were no significant differences in the number of lymph node dissections,operation time and intraoperative blood loss between the two groups(P>0.05).Postoperative complications were found in 5 patients in the research group and 6 patients in the control group,there was no statistically significant difference between the two groups(P>0.05).There was no anastomotic leakage in the research group,and 1 case in the control group.Conclusion:The preservation of the left colon-sigmoid artery arch during the radical resection of middle and low rectal cancer does not significantly increase the operation time and postoperative complications.The effect of radical resection of tumor is similar to that of traditional surgery.This operation can reduce the anastomotic tension and improve the blood supply of the rectal anastomosis by increasing the length of the proximal intestinal,which may be beneficial to reduce the occurrence of anastomotic leakage and has a good short-term effect.