腹腔镜直肠癌根治术中保留左结肠动脉的临床意义探讨  

Discussion on the clinical significance of preserving left colonic artery during laparoscopic radical resection of rectal cancer

作　　者：池良杰 林达佳[1] 郑羽[1] 王襄瑜[1] 许超[1] 曾长青[1] 薛芳沁[1] 黄良祥[1] 

机构地区：[1]福建医科大学省立临床医学院福建省立医院胃肠外科,福建福州350001

出　　处：《中国现代医生》2017年第35期39-42,共4页China Modern Doctor

摘　　要：目的探讨腹腔镜直肠癌根治术中保留左结肠动脉的临床意义。方法回顾性分析2016年6月~2017年4月于我院胃肠外科行腹腔镜下直肠癌根治术病例137例,根据是否行保留左结肠动脉分为不保留LCA组和保留LCA组,比较两组淋巴结清扫数目、肠系膜下动脉根部淋巴结清扫数目、吻合口相关并发症发生率及住院时间的差异。结果 75例患者不保留左结肠动脉,62例患者保留左结肠动脉。两组患者均顺利完成手术,术中无明显并发症。不保留LCA组患者术中未见结肠残端缺血而追加切除肠管,保留LCA组患者术中未见因吻合口张力过高而追加行脾曲游离和高位结扎。术中手术时间、淋巴结清扫总数、IMA根部淋巴结清扫数目、吻合口瘘发生率、吻合口出血发生率及术后住院时间均无明显统计学差异(P>0.05)。结论肠系膜下动脉低位结扎与在手术安全性方面与高位结扎是相当的,并可同样彻底地清扫肠系膜下动脉根部淋巴结。Objective To investigate the clinical significance of preserving the left colonic artery during laparoscopic radical resection of rectal cancer. Methods A total of 137 cases of laparoscopic radical resection of rectal cancer in gastroenterology department in our hospital from June 2016 to April 2017 were retrospectively analyzed. According to whether the left colonic artery was retained, the patients were assigned to the LCA non-retaining group and LCA retaining group. The number of lymph node dissection, the number of lymph node dissection in the root part of inferior mesenteric artery, the incidence of anastomotie complications and length of hospital stay were compared between the two groups. Results 75 patients did not retain the left colonic artery, and 62 patients retained the left colonic artery. Two groups of patients were successfully completed surgery, with no significant intraoperative complications. In LCA non-retaining group, additional resection of the intestine due to colon stump ischemia was not seen in the surgery. In LCA retaining group, additional splenic flexure and high ligation due to high anastomotic tension was not seen in the surgery. No statistically significant difference was found in operation time, total number of lymph node dissection, number of lymph node dissection in the root part of IMA, incidence rate of anastomotic fistula, incidence rate of anastomotic bleeding and postoperative length of hospital stay（P〉0.05）. Conclusion Low ligation of the inferior mesenteric artery is equivalent to high ligation in terms of operation safety and can equally clear the root lymph nodes of the inferior mesenteric artery completely.

关 键 词：腹腔镜 直肠癌 根治性手术 左结肠动脉 

分 类 号：R656.7[医药卫生—外科学]