保留左结肠动脉在腹腔镜超低位直肠癌保肛术中的疗效分析  

Analysis of efficacy of left colon artery preservation in ultra-low rectal cancer with laparoscopic anus-preserving operation

作　　者：张海[1] 陈述[1] 张进[1] 徐三荣[1] Zhang Hai;Chen Shu;Zhang Jin;Xu Sanrong(Department of General Surgery,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212001,China)

机构地区：[1]江苏大学附属医院普外科,镇江212001

出　　处：《河南外科学杂志》2021年第6期1-4,共4页Henan Journal of Surgery

基　　金：江苏大学临床专项基金(JDLCZX013)。

摘　　要：目的探讨保留左结肠动脉(LCA)在腹腔镜超低位直肠癌保肛术中的临床疗效。方法回顾性分析江苏大学附属医院普外科2017-01—2020-01行腹腔镜超低位直肠癌保肛术的76例患者的临床资料。分为保留LCA组及不保留LCA组,各38例。比较2组患者的围手术期指标(手术时间、术中出血量、游离脾曲率、肿瘤上切缘切除肠管长度、术中回肠造口率、淋巴结清扫数目、转移淋巴结数目、胃肠功能恢复时间)、术后并发症(吻合口漏、尿潴留、肠梗阻、腹腔感染),以及肿瘤学指标(局部复发率、远处转移率、术后1 a生存率)。结果保留LCA组术中游离脾曲率、回肠造口率及肿瘤上切缘切除肠管长度均低于不保留LCA组,差异有统计学意义(P<0.05)。2组手术时间、术中出血量、淋巴结清扫数目、转移淋巴结数目及胃肠功能恢复时间差异无统计学意义(P>0.05)。保留LCA组术后吻合口漏发生率低于不保留LCA组(P<0.05)。而2组尿潴留、肠梗阻、腹腔感染发生率,以及肛门功能分级差异无统计学意义(P>0.05)。2组术后局部复发率、远处转移率,以及术后1 a的生存率差异无统计学意义(P>0.05)。结论在腹腔镜超低位直肠癌根治术中,保留LCA有助降低术后吻合口漏,而且不影响手术效果。Objective To investigate the efficacy of left colon artery(LCA)preservation in ultra-low rectal cancer with laparoscopic anus-preserving operation.Methods A retrospective analysis was performed on the clinical data of 76 patients undergoing laparoscopic anal preservation for ultra-low rectal cancer from January 2017 to January 2020 in the Department of General Surgery,Affiliated Hospital of Jiangsu University.They were divided into LCA retention group and non-LCA retention group,38 cases in each group.The preoperative data(the operation time,the intraoperative blood loss,the rate of separated spleen flexure and prophylactic stoma,length of excisional bowel distant incisal margin,total number of lymph node dissection,total number of positive lymph node,and the recovery time of gastrointestinal function),postoperative complications(anastomotic leak,urination dysfunction,intestinal obstruction,incidence of intra-abdominal infection,and the anus functions),and oncology data(local recurrence rate,distant transfer rate,and overall survival rate at 1 year post-operation)were compared between the two groups.Results Compared with the controls,the rate of separated spleen flexure and prophylactic stoma,the length of excisional bowel distant incisal margin were lower in the observation group(P<0.05);there were no significant difference between the two groups in terms of the operation time,the intraoperative blood loss,total number of lymph node dissection and positive lymph node,the recovery time of gastrointestinal function(P>0.05).The rate of anastomotic leak in the observation group was lower than that of the controls(P<0.05);while no significant difference was found between the two groups among the incidence of urination dysfunction,intestinal obstruction,intra-abdominal infection,and the anus functions(P>0.05).Additionally,there were no significant differences in postoperative local recurrence rate,distant metastasis rate,and 1-year postoperative survival rate between the two groups(P>0.05).Conclusion The left colon ar

关 键 词：超低位直肠癌 保留左结肠动脉 保肛术 吻合口漏 

分 类 号：R735.3[医药卫生—肿瘤]