保留左结肠动脉的腹腔镜低位直肠癌前切除术  

Effect on Preservation of the Left Colonic Artery in Laparoscopic Anterior Resection of Low Rectal Carcinoma

作　　者：成军[1] 周玲[1] 陈涛[1] 李晓刚[1] 廖晓锋[1] 

机构地区：[1]湖北文理学院附属襄阳市中心医院普外科,襄阳441021

出　　处：《中国微创外科杂志》2017年第9期780-782,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：襄阳市科技局课题(襄科计[2014]9-1)

摘　　要：目的探讨腹腔镜低位直肠癌前切除术中处理肠系膜下动脉(inferior mesenteric artery,IMA)时保留左结肠动脉(left colonic artery,LCA)的可行性及临床价值。方法回顾性分析我院2010年5月~2014年10月85例腹腔镜低位直肠癌前切除术的临床资料,其中保留LCA 44例,IMA根部结扎(不保留LCA)41例,比较2组临床病理资料、手术效果及术后并发症。结果 2组手术时间、术中出血量、术后排气时间、第3站淋巴结清扫数目及转移率均无显著性差异(P>0.05)。保留LCA组无游离脾曲及末端回肠造口,不保留LCA组6例游离脾曲(P=0.010),3例行末端回肠造口(P=0.108)。2组术后吻合口漏、复发、转移率差异无统计学意义(P>0.05)。结论腹腔镜低位直肠癌前切除术保留LCA可以保障近端结肠血运,保证第3站淋巴结根治性。Objective To discuss the feasibil ity and c linic al significance of preservat ion of the left colonic artery （LCA） in laparoscopic anterior resection of low rectal carcinoma. Methods The c linic al d a ta of 85 c ases of laparoscopic low re ctal anterior resection in our hospital from May 2010 to October 2014 were retrospectively analyzed, including 44 cases with preservation of LCA and 41 cases without preservation of LCA. The surgical effect, clinical pathological parameters and postoperative complications were compared between the two groups. Results There were no differences in surgical t im e , blood lo s s , postoperative exhaust t im e , and the number of D3 lymph nodes between the two groups （ P 〉 0. 05 ） . No case in the preservation group needed the dissection of the splenic flexure of colon or terminal ileum stoma, while there were 6 cases in the non-preservation group needed the dissection of the splenic flexure of colon （ P = 0. 010 ） and 3 cases receiving terminal ileum stoma following anastomosis （P = 0. 108） . The incidences of anastomotic leakage, recurrence and liver metastasis were similar between the two groups （P 〉 0. 05 ）. Conclusion Laparoscopic anterior resection of low rectal carcinoma with preservation of the LCA can effectively retain the blood supply of proximal and ensure radical dissection of D3 lymph nodes.

关 键 词：低位直肠癌 左结肠动脉 肠系膜下动脉 第3站淋巴结 

分 类 号：R735.37[医药卫生—肿瘤]