腹腔镜直肠癌前切除术中保留左结肠动脉对术后吻合口漏及近期疗效的影响  

Influence of preserving left colic artery during during laparoscopic anterior resection for rectal cancer on anastomotic leakage and recent efficacy

作　　者：张明府 吴永丰[1] 柳东[1] ZHANG Mingfu;WU Yongfeng;LIU Dong(Department of General Surgery,Dachang Hospital of Nanjing city,Nanjing 210035 , China)

机构地区：[1]东南大学附属中大医院江北院区(南京市大厂医院)普外科,南京210035

出　　处：《临床外科杂志》2019年第5期400-404,共5页Journal of Clinical Surgery

摘　　要：目的探讨腹腔镜直肠癌前切除术中保留左结肠动脉(LCA)对病人术后吻合口漏及近期疗效的影响。方法腹腔镜直肠癌前切除术病人100例,根据手术方式分为两组,观察组44例,保留LCA低位结扎肠系膜下动脉(IMA),对照组56例,不保留LCA。比较两组病人术后病理检查结果、围手术期指标、术后并发症发生情况,术前及术后6、12个月测定血清抗血管生成趋化因子CXCL9、可溶性E-选择素(sE-selectin)、癌胚抗原(CEA)、糖类抗原199(CA199),统计1年和3年复发转移率和生存率。结果两组一般资料及术后病理资料(第3站淋巴结转移率、病理类型、TNM分期)比较,差异无统计学意义(P>0.05)。观察组与对照组的淋巴结清扫数分别为(12.44±1.92)枚和(12.61±2.23)枚,手术时间分别为(130.59±17.48)小时和(128.06±16.11)小时,术中出血量分别为(74.85±14.69)ml和(77.43±16.86)ml,两组比较差异均无统计学意义(P>0.05);观察组与对照组的术后排气时间分别为(72.53±1.79)小时和(76.11±2.82)小时,住院时间分别为(5.66±0.45)天和(6.22±0.53)天,差异有统计学意义(P<0.05)。观察组切口感染、肠梗阻、尿潴留、性功能障碍、控便不佳发生率分别为0.00、2.27%、4.55%、2.27%、2.27%,对照组分别为3.57%、3.57%、7.14%、3.57%、8.93%,差异无统计学意义(P>0.05);观察组无吻合口漏发生,对照组为10.71%,差异有统计学意义(P<0.05)。术后6、12个月,两组血清CXCL9、sE-selectin、CEA、CA199水平均低于术前(P<0.05),但组间比较差异无统计学意义(P>0.05)。术后1、3年,观察组复发转移率分别为4.55%、20.45%,对照组分别为3.57%和19.64%,两组比较差异无统计学意义(P>0.05);观察组总生存率分别为97.73%、84.09%,对照组分别为100.00%和85.71%,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有利于保护吻合口近端血运,降低术后吻合口漏发生率,且不增加手术难度及术后复发转移�Objective To explore the influence of preserving left colic artery(LCA)during during laparoscopic anterior resection for rectal cancer on anastomotic leakage and recent efficacy.Methods The clinical data of 138 patients undergoing laparoscopic anterior resection for rectal cancer r were retrospectively analyzed.The patients were divided into two groups according to the operation method:62 patients with preservation of LCA with low ligation of the inferior mesenteric artery(IMA)as the observation group,76 patients without preservation of LCA and high ligation of the IMA as control group.The general data,postoperative pathological findings,perioperative indicators,and postoperative complications were compared between the two groups.Serum anti-angiogenic chemokine CXCL9,soluble E selectin(sE-selectin),carcinoembryonic antigen(CEA)and carbohydrate antigen 199(CA199)were measured before and 6,12 months after surgery.All were followed up for 3 years to report recurrence and metastasis.Results There was no significant differences in general data and postoperative pathological findings(3 rd station lymph node metastasis rate,pathological type,TNM staging)between the two groups(P>0.05).There was no significant difference in the number of lymph node dissections [(12.44±1.92)vs(12.61±2.23)],operation time [(130.59±17.48)h vs(128.06±16.11)h],intraoperative blood loss [(74.85±14.69)ml vs(77.43±16.86)ml] between the observation group and the control group(P>0.05),while the difference of postoperative exhaust time [(72.53±1.79)h vs(76.11±2.82)h] and the postoperative hospital stay[(5.66±0.45)d vs(6.22±0.53)d] between the two groups was significant(P<0.05).There was no significant differences in incision infection(0 vs 3.57%),intestinal obstruction(2.27% vs 3.57%),urinary retention(4.55% vs 7.14%),sexual dysfunction(2.27% vs 3.57%),poor stool control(2.27% vs 8.93%)between the observation group and the control group(P>0.05),while the difference of anastomotic leakage(0 vs 10.71%)between the two groups was significant(P

关 键 词：腹腔镜直肠癌前切除术 直肠癌 左结肠动脉 吻合口漏 近期疗效 

分 类 号：R735.37[医药卫生—肿瘤]