保留左结肠动脉低位结扎肠系膜下动脉技术在腹腔镜直肠癌前切除术中的应用及疗效分析  

Application and Curative Effect Analysis of Preservation of the Left Colic Artery of Inferior Mesenteric Artery in Laparoscopic Anterior Resection of Rectal Cancer

作　　者：仇爱峰[1] 施育华[1] 王学斌[1] 葛国侃 

机构地区：[1]盐城市第三人民医院普外科,江苏盐城224001

出　　处：《中外医疗》2017年第25期27-29,共3页China & Foreign Medical Treatment

摘　　要：目的探讨保留左结肠动脉(left colic artery,LCA)低位结扎肠系膜下动脉(Inferior mesenteric artery,IMA)技术应用于腹腔镜直肠癌前切除术中的安全性及近期疗效。方法回顾性分析2013年1月—2017年1月盐城市第三人民医院普外科收治的68例腹腔镜直肠癌前切除患者的临床资料,将患者随机分为保留LCA组(低位组)34例和不保留LCA组(高位组)34例,比较两组患者术中情况及术后疗效。结果高位组有4例(11.7%)出现结肠残端缺血性改变而扩大结肠切除范围。低位组手术时间、术中出血量均高于高位组(P<0.05),而清扫淋巴结数、IMA根部淋巴结清扫数、吻合口瘘发生率、术后排气时间差异无统计学意义(P>0.05);低位组手术时间(min)、术中出血量(m L)均高于高位组[(165.8±17.4)min vs(135.6±13.2)min、(100.6±20.1)m L vs(86.5±15.2)m L,P<0.05]而清扫淋巴结数[(14.6±2.6)枚vs(16.2±4.3)枚]、IMA根部淋巴结清扫数[(2.8±0.4)枚vs(2.6±0.5)枚]、吻合口瘘发生率(11.7%vs17.6%)、术后排气时间[(3.0±0.4)d vs(2.8±0.7)d]均差异无统计学意义(P>0.05);术后复发率高位组、低位组分别为6.1%(2/33)、15.6%(5/32);远处转移率分别为15.2%(5/33)、15.6%(5/32),两组术后复发率及远处转移率均差异无统计学意义(P>0.05)。结论腹腔镜直肠癌前切除术中保留LCA低位结扎IMA技术安全可行,可以完成与高位结扎同样彻底的淋巴结清扫,有与高位结扎相同的远期疗效。Objective This paper tries to investigate the safety and short-term curative effect of preservation of the left colic artery(LCA) and low ligation of inferior mesenteric artery(IMA) in laparoscopic radical operation for rectal cancer. Methods Clinical data of 68 rectal cancer patients undergoing laparoscopic radical operation in Department of General Surgery of the Yancheng Third People's Hospital from January 2013 to January 2017 were retrospectively analyzed, and these patients were randomly divided into the preservation LCA group(low ligation group) and the non preservation LCA group(high ligation group), with 34 cases in each group. The intraoperative conditions and postoperative effect of the two groups were compared. Results 4 cases(11.7%) in high ligation group presented ischemic changes in colonic stump during operation receiving additional colonic resection. The operating time and blood loss in low ligation group were longer and larger in low ligation group than those in the high ligation group(P<0.05); there were no significant differences between the two groups in lymph node count, IMA root lymph node dissection, anastomotic fistula incidence, postoperative exhaust time(P>0.05). The operating time and blood loss in the operation of the low ligation group were higher than that of the high ligation group[(165.8±17.4)min vs(135.6±13.2)min,(100.6±20.1)m L vs(86.5±15.2)m L,P<0.05); there were no significant differences in the number of lymph node count and IMA root lymph node dissection [(14.6 ±2.6) vs(16.2 ±4.3),(2.8 ±0.4) vs 2.6 ±0.5)], the incidence of anastomotic fistula(11.7% vs17.6%), the postoperative exhaust time[(3.0±0.4)d vs(2.8±0.7)d](P>0.05). The recurrence rate in the high ligation group and the low ligation group was 6.1%(2/33) and 15.6%(5/32) respectively and the distant metastasis rate was 15.2%(5/33)and 15.6%(5/32) respectively. There was no significant difference between the two groups in postoperative recurrence rate and distant metastasis rate(P <0.05). Conclusion Laparoscopic

关 键 词：直肠肿瘤 腹腔镜手术 肠系膜下动脉 左结肠动脉 

分 类 号：R735.37[医药卫生—肿瘤]