保留左结肠动脉的腹腔镜直肠癌根治术在高龄患者中的应用研究  

A study on preservation of the left colonic artery in laparoscopic radical operation for elderly patients with rectal cancer

作　　者：曹金鹏[1] 计勇[1] 杨平[1] 余思[1] 李志澄[1] 罗特东[1] 张健[1] 陈振声 CAO Jin-peng;JI Yong;YANG Ping(Department of Gastrointestinal Surgery,First People′s Hospital of Foshan,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院胃肠外科,广东佛山528000

出　　处：《腹腔镜外科杂志》2020年第8期598-602,共5页Journal of Laparoscopic Surgery

基　　金：广东省医学科研基金项目(B2018080)。

摘　　要：目的:探讨高龄患者行保留左结肠动脉的腹腔镜直肠癌根治术的安全性与可行性。方法:回顾分析2011年1月至2019年12月233例70岁以上直肠癌患者的临床资料,其中123例接受保留左结肠动脉的腹腔镜直肠癌前切除术(低位结扎组),110例接受肠系膜下动脉根部结扎的腹腔镜直肠癌前切除术(高位结扎组),比较两组患者术前临床资料、手术相关指标及术后恢复指标。结果:两组患者术前临床资料差异无统计学意义(P>0.05)。两组均无手术相关死亡病例。低位结扎组与高位结扎组手术时间[(175.3±47.2)min vs.(165.2±48.1)min]、术中出血量[(87.5±60.9)mL vs.(82.5±65.5)mL]、肛门排气时间[(2.7±1.2)d vs.(3.0±1.3)d]、进食流质时间[(2.8±1.6)d vs.(3.1±1.7)d]、住院时间[(9.6±6.3)d vs.(10.3±4.8)d]、淋巴结获取数量[(15.2±3.8)vs.(16.0±4.2)]、术后并发症发生率(22.0%vs.29.1%)差异均无统计学意义(P>0.05)。两组术后吻合口漏发生率(2.4%vs.8.2%)差异有统计学意义(P<0.05)。结论:高龄患者行保留左结肠动脉的腹腔镜直肠癌根治术是安全、可行的,可降低术后吻合口漏发生率。Objective:To investigate the safety and feasibility of preservation of the left colonic artery in laparoscopic radical operation for elderly patients with rectal cancer.Methods:A retrospective analysis was conducted among 233 patients of rectal cancer who were over 70 years old in department of gastrointestinal surgery,First People's Hospital of Foshan from Jan.2011 to Dec.2019.123 patients undergoing laparoscopic anterior resection with preservation of the left colonic artery(low ligation group)were compared with 110 patients undergoing laparoscopic anterior resection with ligation of the inferior mesenteric artery at the origin from the aorta(high ligation group).The two groups were compared with each other in terms of preoperative clinical data,details of operations and recovery after operations.Results:No significant differences were found in preoperative clinical data(P>0.05).No surgery-related death occurred.There were no significant differences in average operative time[(175.3±47.2)min vs.(165.2±48.1)min],blood loss[(87.5±60.9)mL vs.(82.5±65.5)mL],time to anal flatus[(2.7±1.2)d vs.(3.0±1.3)d],time to liquid diet[(2.8±1.6)d vs.(3.1±1.7)d],hospital stay[(9.6±6.3)d vs.(10.3±4.8)d],the number of lymph node harvested[(15.2±3.8)vs.(16.0±4.2)],postoperative complications incidence(22.0%vs.29.1%)between the low ligation group and high ligation group.The incidence of anastomotic leakage was 2.4%in the low ligation group and 8.2%in the high ligation group(P<0.05).Conclusions:The preservation of the left colonic artery in laparoscopic radical operation for elderly patients with rectal cancer can be performed safely and feasibly,and can reduce the incidence of postoperative anastomotic leakage.

关 键 词：直肠肿瘤 腹腔镜检查 左结肠动脉 吻合口漏 老年人 

分 类 号：R735.37[医药卫生—肿瘤]