保留左结肠动脉在腹腔镜直肠癌根治术中的临床疗效观察

Left Colic Artery Preservation During Laparoscopic Resection for Rectal Cancer

目的:探讨保留左结肠动脉(LCA)在腹腔镜直肠癌根治术中的临床效果。方法:回顾性分析接受腹腔镜直肠癌根治术的中低位直肠癌患者98例,根据术中LCA保留与否分为保留组(45例)和不保留组(53例),比较2组患者术中情况(手术时间、出血量、标本切除长度)、术后病理及术后恢复情况(术后排气时间、术后排便时间、住院时间)和并发症等临床指标。结果:2组手术时间、术中出血量比较,差异无统计学意义(P>0.05);2组淋巴结清扫总数[(16.67±4.45)vs(18.02±6.84)枚]、253组淋巴结清扫总数[(2.87±1.77)vs(3.13±1.43)枚]比较差异均无统计学意义(P>0.05);保留组术后排气时间[(2.02±0.72)vs(2.79±0.77)d]及排便时间[(3.04±1.87)vs(3.92±1.16)d]均优于不保留组,差异有统计学意义(P<0.05);保留组术后并发症总发生率(13.33%)低于不保留组(22.64%),但差异无统计学意义(P>0.05)。结论:腹腔镜直肠癌根治术中保留LCA,不影响淋巴结清扫,可改善患者术后胃肠道功能,手术方式安全可行。

Objective:To explore the clinical significance of preserving the left colonic artery(LCA)in laparoscopic radical rectal cancer surgery.Methods:Ninety-eight patients with low to medium rectal cancer who underwent laparoscopic radical rectal cancer surgery at the Department of Gastroenterology,Retrospectively analyzed and divided into 2 groups according to whether the left colonic artery(LCA)was preserved intraoperatively or not:the preserved group(45 cases)and the non-preserved group(53 cases),and the general conditions,intraoperative conditions,postoperative pathology,and postoperative recovery and other clinical indicators.of patients in the 2 groups were compared.Results:There was no statistically significant difference between the 2 groups in terms of operative time and intraoperative bleeding(P>0.05).There was no statistically significant difference between the 2 groups in terms of the total number of lymph nodes cleared(16.67±4.45 vs 18.02±6.84)and the total number of lymph nodes cleared in group 253(2.87±1.77 vs 3.13±1.43)(P>0.05).The postoperative time to exhaustion[(2.02±0.72)vs(2.79±0.77)d]and time to defecation[(3.04±1.87)vs(3.92±1.16)d]were better in the preserved group than in the non-preserved group,and the difference was statistically significant(P<0.05).The overall incidence of postoperative complications was lower in the preserved group 13.33%than in the nonpreserved group 22.64%,but the difference was not statistically significant(P>0.05).Conclusion:LCA is preserved during laparoscopic radical rectal cancer surgery without affecting lymph node dissection,which can improve patients’postoperative gastrointestinal function and is a safe and feasible procedure.