接受新辅助放化疗的中低位直肠癌患者行保留左结肠动脉手术的临床研究  

Clinical study on intraoperative preservation of left colon artery in patients with middle-low rectal cancer undergone neoadjuvant chemoradiotherapy

作　　者：陶俊[1] 束宽山[1] 王贵和[1] TAO Jun;SHU Kuanshan;WANG Guihe(Department of Gastrointestinal Surgery,Tongling People′s Hospital,Tongling 244000,China)

机构地区：[1]铜陵市人民医院胃肠外科,安徽铜陵244000

出　　处：《皖南医学院学报》2021年第4期372-374,381,共4页Journal of Wannan Medical College

基　　金：铜陵市科技计划项目(2017NS21);铜陵市卫生健康委医学科研项目(卫科研[2019]15号)。

摘　　要：目的:探讨接受新辅助放化疗的中低位直肠癌患者术中保留左结肠动脉(LCA)的临床意义。方法:采用回顾性研究方法收集铜陵市人民医院胃肠外科2014年1月~2020年5月收治的102例中低位直肠癌患者临床资料,根据是否保留LCA分为两组,保留LCA组48例,非保留LCA组54例,比较两组患者术中及术后情况。结果:术后病理完全缓解8例,部分缓解68例,疾病稳定16例,疾病进展10例,有效率达74.5%。两组患者手术时间、术中出血量、吻合口出血、肠系膜根部淋巴结清扫数目、是否游离脾区、住院时间等比较,差异均无统计学意义。保留LCA组吻合口漏发生率(2.1%)低于非保留LCA组(14.8%),但差异无统计学意义(P=0.056)。保留LCA组预防性造口发生率低于非保留LCA组,差异有统计学意义(P=0.017)。结论:对接受新辅助放化疗后中低位直肠癌患者行保留LCA手术并不增加手术难度,同样可清扫肠系膜根部淋巴结,而且还能有效降低术后预防性造口发生。Objective:To investigate the clinical significance of intraoperative preservation of left colon artery in patients with middle-low rectal cancer undergone neoadjuvant chemoradiotherapy.Methods:Retrospective study was conducted concerning the clinical data of 102 cases of middle-low rectal cancer treated in our hospital between January 2014 and May 2020.The cases were divided into two groups according to whether the left colon artery(LCA)was preserved or not,including LCA reserved group(n=48)and non-LCA reserved group(n=54).Then the two groups were compared regarding the intraoperative observations and clinical outcomes.Results:Pathologic complete response(pCR),partial remission,stable disease and disease progression following surgery were found in 8,68,16 and 10 cases,respectively.The effective rate was 74.5%.The two groups were not significantly different in operative time,intraoperative blood loss,anastomotic bleeding,the number of lymph nodes dissected at the mesenteric root,free spleen,and days of hospital stay.Incidence of anastomotic leakage was lower in LCA reserved group(2.1%)than in non-LCA reserved group(14.8%),without statistical significance(P=0.056),and the incidence of prophylactic stoma was lower in LCA reserved group than in non-LCA reserved group as well(P=0.017)(14.8%).Conclusion:Preservation of the left colon artery will not add difficulty to the surgery,yet can facilitate easy dissection of the lymph nodes at the mesenteric root,and effectively reduce necessity of prophylactic stoma in patients with middle-low rectal cancer undergone neoadjuvant chemoradiotherapy.

关 键 词：直肠肿瘤 新辅助治疗 左结肠动脉 吻合口漏 

分 类 号：R735.37[医药卫生—肿瘤]