腹腔镜下直肠癌根治术中保留左结肠动脉对淋巴结清除术及肠功能恢复的影响  

Effect of preservation of left colonic artery on lymph node dissection and bowel function recovery in laparoscopic radical resection of rectal cancer

作　　者：张军[1] 华进[2] 季恩敏[1] 李光云[1] 田景中[1] Zhang Jun;Hua Jin;Ji Enmin;Li Guangyun;Tian Jingzhong(Department of Gastroenterology,Bozhou People's Hospital,Anhui Bozhou 236800,China;Gastroenterology Department of the First Affiliated Hospital of Fujian Medical University,Fujian Fuzhou 350005,China)

机构地区：[1]亳州市人民医院胃肠外科,安徽亳州236800 [2]福建医科大学附属第一医院胃肠外科,福建福州350005

出　　处：《现代肿瘤医学》2019年第19期3451-3455,共5页Journal of Modern Oncology

基　　金：2017年福建省中青年教师教育科研项目(编号:JAT170239)

摘　　要：目的:探讨腹腔镜下直肠癌根治术中保留左结肠动脉(LCA)对淋巴结清除术及肠功能恢复的影响。方法:回顾性选择了2010年2月至2013年12月我院95例腹腔镜直肠癌根治术患者,其中保留LCA47例(研究组),不保留LCA48例(对照组),比较两组患者手术情况(手术时间、术中出血量、术中转开腹率、预防性回肠造口、游离脾曲)、术中淋巴结清扫情况(肠系膜根部淋巴结清扫数、阳性淋巴结检出率)、术后肠道功能恢复情况(术后肛门首次排气排便时间、腹胀腹痛持续时间、住院时间)、术后并发症发生和肿瘤复发转移、5年死亡率、无肿瘤进展(PFS)情况。结果:两组患者手术时间、术中出血量、术中转开腹率对比差异无统计学意义(P>0.05),研究组回肠造口比例、游离脾曲比例低于对照组(P<0.05)。两组患者术中淋巴结清扫数目、阳性淋巴结检出率对比差异均无统计学意义(P>0.05)。两组首次排气时间无显著差异性(P>0.05),但研究组首次排便时间、腹痛腹胀持续时间、住院时间明显低于对照组(P<0.05)。研究组术后吻合口瘘发生率低于对照组(0.00%vs10.42%,P<0.05),切口感染、尿潴留、性功能障碍发生率与对照组无差异(P>0.05)。研究组患者肿瘤复发率、转移率、5年死亡率、无进展生存率与对照组差异无统计学意义(P>0.05)。结论:腹腔镜直肠癌根治术中保留LCA可提供吻合口良好血供,避免术中回肠造口、游离脾曲术,促进术后肠功能恢复,对淋巴结清扫术无影响,不增加肿瘤复发和转移的风险。Objective:To investigate the effect of preserving left colon artery(LCA)on lymph node dissection and intestinal function recovery in laparoscopic radical resection of rectal cancer.Methods:95 cases of laparoscopic radical resection of rectal cancer in our hospital from February 2010 to December 2013 were selected,including LCA47(study group)and 48 cases(control group).The operation time,the amount of intraoperative bleeding,conversion to open rate,the preventive enterostomy,splenic flexure mobilization,intraoperative lymph node dissection(lymph node clearance in the mesenteric root,positive lymph node detection rate),postoperative intestinal function recovery(postoperative anus first exhaust and defecation time,abdominal distention and abdominal pain duration,hospitalization time),postoperative complications and tumor recurrence and metastasis in the two groups were conpared.Results: There was no significant difference in the operation time,intraoperative blood loss,and intraoperative laparotomy between the two groups( P >0.05).The proportion of ileostomy and splenic flexure mobilization was lower in the study group than in the control group( P <0.05).There was no significant difference in the number of intraoperative lymph node dissection and positive lymph node detection between the two groups( P >0.05).There was no significant difference in the first exhaust time between the two groups( P >0.05),but the first defecation time,abdominal pain and bloating duration,and hospitalization time were significantly lower in the study group than in the control group ( P <0.05).The postoperative anastomotic rate was lower in the study group than in the control group (0.00% vs 10.42%,P <0.05).The incidence of urinary retention and sexual dysfunction was not different from that of the control group( P >0.05).There was no significant difference in tumor recurrence rate,metastasis rate,5-year mortality rate and progression-free survival between the study group and the control group( P >0.05).Conclusion:The preservation of LCA

关 键 词：腹腔镜 直肠癌根治术 左结肠动脉 淋巴结清除术 肠功能 

分 类 号：R735.37[医药卫生—肿瘤]