术中低位结扎保留左结肠动脉对腹腔镜直肠癌前切除术患者的影响

Effect of Intraoperative Low Ligation and Preservation of Left Colonic Artery on Patients Undergoing Laparoscopic Anterior Resection of Rectal Cancer

目的:研究术中保留左结肠动脉对腹腔镜直肠癌切除术患者的影响。方法:选择2020年1月—2022年1月重庆市黔江区中医院收治的60例直肠癌患者作为研究对象,以随机数表法将患者分为试验组与对照组,各30例。两组均行腹腔镜直肠癌前切除术治疗,试验组术中低位结扎保留左结肠动脉,对照组术中高位结扎且不保留左结肠动脉。比较两组手术相关指标、术后相关指标、并发症及低位前切除综合征(low anterior resection syndrome,LARS)。结果:60例患者均顺利完成手术,无中转开腹者,住院期间无术后死亡病例。两组手术时间、术中出血量、腹腔引流量、肿瘤近端切缘距离、肿瘤远端切缘距离、淋巴结清扫情况、腹腔管引流时间、插置尿管时间、住院时间及术后吻合口瘘、吻合口狭窄、吻合口出血发生率比较,差异无统计学意义(P>0.05)。试验组术后肠鸣音恢复时间、术后肛门排气时间短于对照组,差异有统计学意义(P<0.05)。试验组住院期间、随访1年LARS发生率低于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜直肠癌前切除术中低位结扎保留左结肠动脉,对手术相关指标及术后吻合口相关并发症影响较小,但有利于术后胃肠功能恢复,还能减少LARS发生。

Objective:To investigate the effect of intraoperative low ligation and preservation of left colonic artery on patients undergoing laparoscopic anterior resection of rectal cancer.Method:A total of 60 patients with rectal cancer who admitted to Chongqing Qianjiang Traditional Chinese Medicine Hospital from January 2020 to January 2022 were selected as the research objects,the patients were divided into the experimental group and the control group by random number table method,with 30 cases in each group.Two groups were treated with laparoscopic anterior resection of rectal cancer,the left colonic artery was retained by low ligation in the experimental group,and the left colonic artery was not retained by high ligation in the control group.The operation related indexes,postoperative related indexes,complications and low anterior resection syndrome(LARS)were compared between two groups.Result:All 60 patients successfully completed the operation without conversion to laparotomy,and there were no postoperative deaths during hospitalization.There were no significant differences in the operation time,intraoperative blood loss,abdominal drainage volume,proximal margin distance of tumor,distal margin distance of tumor,lymph node dissection,abdominal drainage time,indwelling catheter time,hospitalization time and incidence of postoperative anastomotic leakage,anastomotic stenosis and anastomotic bleeding between two groups(P>0.05).The occurrence time of postoperative bowel sounds and postoperative anal exhaust time in the experimental group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The incidence of LARS during hospitalization and 1-year follow-up in the experimental group were lower than that in the control group,and the differences were statistically significant(P<0.05).Conclusion:Intraoperative low ligation and preservation of left colonic artery in laparoscopic anterior resection of rectal cancer has little effect on the operation-related indicators and postoperative anastomotic-related complications,which is conducive to the recovery of postoperative gastrointestinal function and can reduce the occurrence of LARS.