腹腔镜直肠癌前切除术保留左结肠动脉对患者术后恢复情况的影响

Effect of left colic artery preservation in laparoscopic anterior excision surgery of rectal cancer on postoperative recovery

目的探讨腹腔镜直肠癌前切除术保留左结肠动脉对患者术后恢复情况的影响.方法对2017年1月至2021年12月于南通市海门区人民医院接受腹腔镜直肠癌前切除术治疗的100例直肠癌患者进行前瞻性研究.采用随机数字法对患者进行分组,其中对照组50例,不保留左结肠动脉;研究组50例,保留左结肠动脉.对比两组患者围手术期指标、临床治疗总有效率、胃肠功能指标[胃动素(MTL)和胃泌素(GAS)]、肛肠动力学指标[肛管静息压(ARP)、肛管最大收缩压(MSP)、高压区长度(HPZ)、直肠肛管抑制反射阈值(AIRT)、直肠静息压(RRP)和最大耐受容量(MTV)]、并发症总发生率以及生活质量.结果研究组患者吻合口距肛缘距离、术后肛门排气时间、肠道功能恢复时间、脾曲游离以及近端肠管缺血改变情况与对照组比较,差异均有统计学意义(均P<0.05).研究组治疗总有效率为92.0%,对照组治疗总有效率为76.0%,研究组明显高于对照组(P<0.05).两组患者术后48 h MTL、GAS水平均明显下降,研究组明显低于对照组,差异均有统计学意义(均P<0.05).两组患者术后15 d ARP、MSP、HPZ和MTV水平均明显降低,研究组明显高于对照组,差异均有统计学意义(均P<0.05).两组患者术后15 d AIRT、RRP水平均明显升高,研究组明显低于对照组,差异均有统计学意义(均P<0.05).研究组并发症的总发生率为10.0%,对照组并发症的总发生率为26.0%,研究组明显低于对照组(P<0.05).两组患者术后15 d社交、角色、心理、身体评分均明显升高,研究组明显高于对照组,差异均有统计学意义(均P<0.05).结论行腹腔镜直肠癌前切除术治疗的直肠癌患者,术中保留左结肠动脉与不保留左结肠动脉比较,治疗效果较好,肠道功能恢复较快,且并发症发生率较低,生活质量较高.

Objective To investigate the effect of left colic artery preservation in laparoscopic anterior excision surgery of rectal cancer on postoperative recovery.Methods A prospective study was conducted on 100 patients with rectal cancer who underwent laparoscopic anterior excision surgery of rectal cancer in Haimen District People's Hospital of Nantong City from January 2017 to December 2021.Patients were grouped according to Yandom number,including control group(50 cases without left colic artery preservation)and research group(50 cases with left colic artery preservation).Perioperative indexes,overall clinical treatment response rate,gastrointestinal function indexes[motilin(MTL)and gastrin(GAS)],anorectal dynamics indexes[anal canal resting pressure(ARP),anal canal maximum systolic pressure(MSP),high pressure zone length(HPZ),anorectal inhibitory reflex threshold(AIRT),rectal resting pressure(RRP),and maximum tolerance volume(MTV),overall complication rate,and quality of life were compared between the two groups.Results The differences of the distance from the anastomosis to the anal margin,postoperative anal exhaust time,intestinal function recovery time,splenic flexure and proximal intestinal ischemia between the control group and research group were statistically significant(all P<0.05).The overall clinical treatment response rate of the research group(92.0%)was higher than that of the control group(76.0%),and the difference was statistically significant(P<0.05).The levels of MTL and GAS at in both groups were significantly decreased at 48 hours after surgery,and the levels ofMTL and GAS 48 hours after surgery of the research group were lower than those of the control group,with statistical significance(all P<0.05).The levels of ARP,MSP,HPZ and MTV in both groups were significantly decreased at 15 days after surgery,and the levels ofARP,MSP,HPZ and MTV at 15 days after surgery of the research group were higher than those of the control group,with statistical significance(all P<0.05).The levels ofAIRT and RRP in both groups were significantly increased at 15 days after surgery,and the levels of AIRT and RRP at 15 days after surgery of the study group were lower than those of the control group,with statistical significance(all P<0.05).The overall complication rate was 10.0%and 26.0%in the research and control group,respectively,the difference was statistically significant(P<0.05).Social,role,psychological and physical scores of both groups were significantly increased at 15 days after surgery,and these scores at 15 days after surgery ofthe research group were higher than those of the control group,with statistical significance(all P<0.05).Conclusions Patients with rectal cancer who underwent laparoscopic anterior excision surgery of rectal cancer had better clinical treatment response,rapider intestinalfunction recovery,lower complication rate,and higherquality oflife in those with lft colic artery preservation compared with those without leftcolic artery preservation.