老年中低位直肠癌患者腹腔镜直肠前切除术中保留左结肠动脉的疗效分析  

Clinical effect analysis of preserving left colic artery during laparoscopic rectal anterior resection in elderly patients with middle and low rectal cancer

作　　者：张曙栋 朱宣进[2] 张金刚 何国锐 黄勇[1,2] ZHANG Shu-dong;ZHU Xuan-jin;ZHANG Jin-gang(Guizhou Medical University,Guiyang 550004,China;Department of General Surgery,Guangzhou Red Cross Hospital Affiliated to Jinan University)

机构地区：[1]贵州医科大学,贵州贵阳550004 [2]暨南大学附属广州红十字会医院普通外科

出　　处：《腹腔镜外科杂志》2021年第7期520-524,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨老年中低位直肠癌患者行腹腔镜直肠前切除术中保留左结肠动脉(LCA)的可行性及临床疗效。方法:回顾分析2016年1月至2019年12月66例行腹腔镜直肠前切除术的老年中低位直肠癌患者的临床资料,其中33例术中保留LCA(保留LCA组);33例术中行肠系膜下动脉根部结扎不保留LCA(不保留LCA组)。对比分析两组患者基本资料及术中、术后、随访、标本等相关指标。结果:保留LCA组术后排气时间[(56.45±22.06)h vs.(70.61±26.39)h]、术后住院时间[(11.03±3.56)d vs.(13.36±4.94)d]短于不保留LCA组(P<0.05);两组手术时间、术中出血量、进食流质时间、253组淋巴结清扫数量、淋巴结清扫总数、术后总并发症发生率、吻合口漏发生率及短期随访指标差异均无统计学意义(P>0.05)。结论:老年中低位直肠癌患者行腹腔镜直肠前切除术中保留LCA是安全、可行的,不影响肠系膜下动脉根部淋巴结的清扫、短期复发、转移、死亡率,且可缩短术后排气时间、术后住院时间,具有较好的临床应用价值。Objective:To explore the feasibility and clinical effect of preserving the left colonic artery(LCA)during laparoscopic rectal anterior resection in elderly patients with middle or low rectal cancer.Methods:The clinical data of 66 elderly patients with middle or low rectal cancer who underwent laparoscopic rectal anterior resection from Jan.2016 to Dec.2019 were retrospectively analyzed.Patients were allocated to reservation of the LCA group(n=33)and non-retention of LCA group(n=33).The basic data,intraoperative and postoperative conditions,follow-up and the specimen related indicators were compared between the two groups.Results:The postoperative exhaust time[(56.45±22.06)h vs.(70.61±26.39)h]and the hospital stay[(11.03±3.56)d vs.(13.36±4.94)d]of the reservation group were shorter than those of the non-retention group(P<0.05).And there were no significant differences in operation time,intraoperative bleeding,fluid intake time,number of lymph node dissections in group 253,total lymph node dissections,postoperative total complications incidence,anastomotic leakage incidence and the short-term follow-up indicators between the two groups(P>0.05).Conclusions:It is safe and feasible to preserve the LCA in elderly patients with middle and low rectal cancer during laparoscopic rectal anterior resection.It does not affect the dissection of the lymph nodes at the root of the inferior mesenteric artery,the short-term recurrence rate,and metastasis rate,mortality rate,and could significantly reduce postoperative exhaust time and shorten postoperative hospital stay.Thus it has good clinical application value.

关 键 词：直肠肿瘤 腹腔镜检查 左结肠动脉 老年人 

分 类 号：R735.37[医药卫生—肿瘤]