保留左结肠动脉3D腹腔镜直肠癌根治术的围术期指标观察  

Clinical observation of 3D laparoscopic radical rectectomy for rectal cancer with left colic artery reserved

作　　者：李松岩[1,2] 宋林杰 那兴邦 李宇轩 胡子龙[1] 张红亮[1] 杜晓辉[1] 

机构地区：[1]解放军总医院普通外科,北京100853 [2]盘锦市中心医院普通外科,辽宁盘锦124000

出　　处：《解放军医学院学报》2018年第2期114-116,125,共4页Academic Journal of Chinese PLA Medical School

基　　金：国家自然基金资助项目(61170123)~~

摘　　要：目的探讨3D腹腔镜直肠前切除术保留左结肠动脉的安全性、可行性及围术期效果。方法回顾性分析2015年1月-2017年1月在解放军总医院普通外科行3D腹腔镜直肠前切除术治疗的115例患者。其中观察组55例,行保留左结肠动脉的3D腹腔镜辅助直肠前切除术;对照组60例,行高位结扎肠系膜下动脉,不保留左结肠动脉的3D腹腔镜直肠前切除术。结果两组患者性别、年龄及疾病程度等基线资料无统计学差异。观察组与对照组手术时间[(123.4±8.5)min vs(120.4±9.5)min,P=0.061]、手术出血量[(54.9±20.7)ml vs(53.4±18.2)ml,P=0.752]、淋巴结清扫数目[(16.4±3.6)枚vs(16.8±2.9)枚,P=0.288]差异均无统计学意义。术后排气时间:观察组(2.9±0.4)d,少于对照组的(3.5±0.5)d(P=0.038);进食流质食物时间:观察组(45.8±5.3)h,少于对照组的(52.4±7.5)h(P=0.001);住院时间:观察组(7.1±2.2)d少于对照组的(11.4±2.7)d(P<0.001);根据术中远近肠管血运情况及吻合口张力大小等,对观察组术中2例行预防性末端回肠造瘘,对照组术中7例行预防性末端回肠造瘘(P=0.038);术后观察组2例出现吻合口瘘,对照组3例吻合口瘘,两组术后吻合口瘘发生率差异无统计学意义,发生吻合口瘘患者经过禁食水、营养支持及腹腔冲洗等对症治疗后均治愈出院。结论与传统高位结扎肠系膜下动脉相比,保留左结肠动脉3D腹腔镜直肠前切除术安全可行,患者术后恢复快,近期临床效果显著。Objective To discuss the safety, feasibility and clinical effectiveness of 3D laparoscopic radical rectectomy for rectal cancer with left colic artery preserved. Methods Clinical data about 115 patients who had undergone routine 3D laparoscopic recectomy in Chinese PLA General Hospital from January 2015 to January 2017 were retrospectively analyzed. Patients were divided into observation group （55 cases with left colic artery preserved） and control group （60 cases without left colic artery preserved）. Results There was no significant difference in basic characteristics such as age and sex, operating time [（124.4 ± 8.5） rain vs （120.4 ± 9.5） min, P=0.061], blood loss [（54.9 ± 20.7） ml vs （53.4 ± 18.2） ml, P=0.752] and the number of harvested lymph nodes [（34.7 ± 8.2） vs （24.2 ± 8.1）, P=0.288]. However, the time to pass gas [（2.9 ± 0.4） d vs （3.5 ± 0.5） d, P=0.038], time to take liquid food [（45.8 ± 5.3） h vs （52.4 ± 7.5） h, P=0.001], and length of hospital stay [（7.1 ± 2.2） d vs （11.4 ± 2.7） d, P 〈 0.001] of observation group were significantly less than those of control group. Prophylactic ileostomy was performed to 2 cases in observation group and 7 cases in control group. After operation, anastomotic leakage occurred in 2 cases in observation group and 3 cases in control group. Conclusion Patients with rectal cancer who have received 3D laparoscopic radical rectectomy with left colic artery reserved recover quickly and achieve better short-term clinical effect.

关 键 词：3D腹腔镜 直肠癌 左结肠动脉 肠系膜下动脉 

分 类 号：R735.37[医药卫生—肿瘤]