保留左结肠动脉的腹腔镜直肠癌根治术在老年患者中的应用价值探讨  

Study on clinical value of laparoscopic radical resection of rectal cancer with left colonic artery sparing in elderly patients

作　　者：赵国栋[1] 王绥能[1] 谢权[1] 梁贤文[1] 刘兵[1] 王定茂 徐瑜杰 彭勃[1] ZHAO Guo-dong;WANG Sui-neng;XIE Quan(Department of Gastrointestinal Surgery,Haikou People's Hospital,Haikou 570208,China)

机构地区：[1]海口市人民医院胃肠外科,海南海口570208

出　　处：《腹腔镜外科杂志》2020年第11期849-852,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨保留左结肠动脉(LCA)的腹腔镜直肠癌根治术在老年患者中应用的安全性及临床价值。方法:回顾分析2015年1月至2019年3月收治的101例行腹腔镜直肠癌根治术的老年(65岁以上)直肠癌患者的临床资料,分为保留LCA组(n=51)与肠系膜下动脉(IMA)高位结扎组(n=50),对比两组术中情况、术后病理情况及术后恢复情况。结果:两组手术方式、术中出血量、造口例数、术后转重症监护病房及术后尿潴留发生率等差异均无统计学意义(P>0.05);保留LCA组术中淋巴结检出数量多于IMA高位结扎组(P<0.05),但手术时间长于IMA高位结扎组(P<0.05)。剔除14例造口患者后,术后3个月Wexner评分≥9分的患者差异无统计学意义(P>0.05);保留LCA组术后首次排气时间、吻合口漏发生率优于高位结扎组(P<0.05)。结论:在老年直肠癌患者中,腹腔镜下保留LCA的直肠癌根治术并未增加术中出血等风险,可取得较高位结扎IMA更彻底的淋巴结清扫,并减少吻合口漏的发生,缩短了排气时间,具有临床推广价值。Objective:To investigate the safety and clinical value of laparoscopic radical resection of rectal cancer with left colonic artery(LCA)sparing in elderly patients.Methods:Retrospective analysis was applied to the clinical data of 101 rectal cancer patients(>65 years old)who underwent laparoscopic radical resection of rectal cancer between Jan.2015 and Mar.2019.There were 51 patients in the LCA sparing group and 50 patients in the group of high ligation of the inferior mesenteric artery(IMA).The differences in intraoperative conditions,postoperative pathological conditions and postoperative recovery between the two groups were compared.Results:There was no statistically significant difference between the two groups in terms of surgical methods,intraoperative bleeding,stoma,postoperative conversion to intensive care unit and postoperative urinary retention(P>0.05).The number of intraoperative lymph nodes was higher in the LCA sparing group than that in the group of high ligation of IMA(P<0.05).However,the operation time of the LCA sparing group was higher than that of group of high ligation of IMA(P<0.05).After eliminating 14 cases of stoma patients,there was no statistically significant difference in the incidence of Wexner score≥9 at 3 months after surgery(P>0.05).Time of the first exhaust and incidence of anastomotic leakage occurring in the LCA sparing group was significantly lower than that in the high ligation group(P<0.05).Conclusions:In elderly patients with rectal cancer,laparoscopic radical resection of rectal cancer with LCA sparing does not increase the risk of intraoperative bleeding.It can achieve more complete lymph node dissection than the high ligation of the IMA.Furthermore,it reduces the incidence of anastomotic leakage and the postoperative patient's exhaust time,this procedure is clinically significant.

关 键 词：直肠肿瘤 腹腔镜检查 左结肠动脉 老年人 

分 类 号：R735.3+7[医药卫生—肿瘤]