保留左结肠动脉的腹腔镜直肠癌手术对患者预后的影响  

Effect of laparoscopic rectal surgery with left colonic artery preservation on the prognosis of patients

作　　者：徐向辉[1] 盛金鑫 钟林[2] 赵忠 XU Xiang-hui;SHEN Jin-xin;ZHONG Lin;ZHAO Zhong(Department of General Surgery HaimenPeople s Hospital Haimen Jiangsu 22610;Department of General Surgery Shanghai General Hospital Shanghai 200080)

机构地区：[1]江苏省海门市人民医院,226100 [2]上海市第一人民医院,200080

出　　处：《现代消化及介入诊疗》2018年第5期548-550,686,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：卫生行业科研专项(201002015)

摘　　要：目的探讨保留左结肠动脉的腹腔镜直肠癌手术对患者预后的影响。方法选取2012年12月至2016年12月在我院行腹腔镜直肠癌根治术的患者63例进行回顾性分析,根据术中是否保留左结肠动脉分为两组,对照组不保留左结肠动脉,观察组保留左结肠动脉。比较两组患者围术期相关指标、术后恢复情况、手术结果及复发和转移情况。结果两组患者的手术时间、术中出血量、淋巴结清扫数目、肿瘤直径、吻合口距齿状线距离、术后排气时间、下床活动时间和住院时间相比无统计学差异(P> 0.05);两组患者切口感染、肠梗阻和腹腔感染的发生率无统计学差异(P> 0.05),观察组吻合口瘘发生率、残端缺血性改变例数和游离脾曲显著低于对照组(P <0.05)。两组患者的复发率和转移率比较无统计学差异(P> 0.05)。结论保留左结肠动脉的腹腔镜直肠癌手术可完成与不保留左结肠动脉的腹腔镜直肠癌手术同样的淋巴结清扫,不增加患者的远期复发率和转移率,可显著降低吻合口瘘发生率、残端缺血性改变例数和游离脾曲,有利于患者康复。Objective To explore the effect of laparoscopic rectal surgery with left colonic arteryreservation on the prognosis of patients. Methods A retrospective analysis was performed on 63 patients whounderwent laparoscopic rectal cancer radical resection in our hospital from December 2012 to December 2016.According to whether left colon artery was retained during operation they were divided into two groups. Thecontrol group did not retain left colon artery while the observation group retained left colon artery. Theperioperative correlative indexes postoperative recovery operation result recurrence and metastasis werecompared between the two groups. Results There were no statistically significant differences between the twogroups in operation time intraoperative blood loss number of lymph node dissection distance from dentateline to anastomotic site postoperative exhaust time diameter of tumor and hospitalization time P 〉 0. 05 .There was no significant difference in postoperative exhaust time out of bed activity time and hospital staybetween the two groups P 〉 0.05 .There was no statistical difference in the incidence of incision infection intestinal obstruction and abdominal infection between the two groups P 〉 0.05 . The incidence of anastomoticleakage residual ischemic changes and free splenic melody in the observation group were significantly lowerthan those in the control group P 〈 0. 05 . There was no significant difference in the recurrence rate andmetastasis rate between the two groups P 〉 0.05 . Conclusion Laparoscopic rectal cancer surgery with leftcolon artery reservation can complete the same lymph node dissection as laparoscopic rectal cancer surgerywithout left colon artery reservation without increasing the long-term recurrence rate and metastasis rate of thepatients and significantly reduce the incidence of anastomotic leakage and residual ischemic changes which isconducive to the patients′ rehabilitation.

关 键 词：保留左结肠动脉 腹腔镜直肠癌手术 预后 

分 类 号：R735.37[医药卫生—肿瘤]