保留左结肠动脉在腹腔镜下直肠癌前切除术中的临床作用  

Clinical effect of preservation of the left colonic artery in laparoscopic anterior resection for rectal cancer

作　　者：牛晋卫[1] 宁武[1] 王文跃[1] 裴东坡[1] 孟凡强[1] 刘质泽[1] 蔡德光[1] 

机构地区：[1]中日友好医院普外科,北京100029

出　　处：《中华医学杂志》2016年第44期3582-3585,共4页National Medical Journal of China

摘　　要：目的探讨保留左结肠动脉（LCA）在腹腔镜下直肠癌前切除术中的临床作用和可行性。方法选择2009年3月至2015年3月期间97例腹腔镜直肠癌前切除术的临床资料，随机分两组，保留左结肠动脉52例，不保留左结肠动脉45例。观察两组手术时间、术中出血量、肠系膜下动脉（IMA）根部淋巴结清扫数目、肠系膜根部淋巴结转移率、横结肠造口情况、吻合口漏情况。结果97例患者全部顺利完成腹腔镜手术，两组手术时间[（121．4±17．5）min与（97．0±19．2）min、术后吻合口漏（0例与3例）、横结肠造口术（0例与4例）]差异均有统计学意义（均P〈0．05），出血量、清扫淋巴结数量、淋巴结转移数量差异均无统计学意义。结论保留左结肠动脉在腹腔镜直肠癌前切除术中对结肠吻合口近端血运提供了充分的保障，避免了吻合口漏的发生。Objective To evaluate the value and feasibility of preservation of the left colonic artery （LCA） in laparoscopic anterior resection for rectal cancer. Methods The clinical data of 97 patiens who received laparoscopic anterior resection of rectal cancer from 2009. 3 to 2015.3 were randomly divided into two groups, including 52 cases with preservation of LCA and 45 cases without preservation of LCA. The operation time, quantity of bleeding, number of lymph nodes removed around the root of inferior mesenteric artery （IMA）, the rate of lymph node metastasis around the root of IMA, the incidence of transverse colostomy and anastomotic leak were compared between the two groups. Results All 97 operations were successfully completed by laparoscopic operation. There were significantly statistical differences in operation time, quantity of bleeding and transverse colon stoma between two groups （P 〈 0. 05 ）, but no difference in the number of lymph nodes removed and the rate of lymph node metastasis. Conclusions The preservation of the left colonic artery in laparoscopic anterior resection of rectal cancer can preserve more supplying vessels for anastomosis and prevent anastomotic leak.

关 键 词：直肠肿瘤 肠系膜下动脉 低位结扎 吻合口漏 

分 类 号：R735.37[医药卫生—肿瘤]