保留左结肠动脉的腹腔镜辅助直肠癌根治术对老年直肠癌患者近期疗效分析  

Short-term efficacy of laparoscopic-assisted radical resection with left colonic artery preservation in elderly patients with recta!cancer

作　　者：余涛[1] 安琦[1] 曹祥龙[1] 崔健 李子建 肖刚[1] 吴国举[1] Yu Tao;An Qi;Cao Xianglong;Cui Jian;Li Zijian;Xiao Gang;Wu Guoju(Department of General Surgery,Beijing Hospital,National Center of Gerontology.Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院普通外科 国家老年医学中心 中国医学科学院老年医学研究所,100730

出　　处：《中华老年医学杂志》2022年第4期447-450,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨保留左结肠动脉(LCA)的腹腔镜辅助直肠癌根治术对老年直肠癌患者的近期疗效。方法回顾性分析2017年12月至2020年12月北京医院胃肠外科接受腹腔镜辅助直肠癌根治术的≥65岁患者168例, 根据手术方法不同分为保留组(保留LCA组)90例和不保留组(不保留LCA组)78例。对比分析两组患者基本资料及术中、术后、临床病理资料。结果两组手术时间[(172.3±35.5)min和(155.5±28.7)min, t=2.182, P=0.103]、术中出血量[(72.6±22.5)ml和(67.3±18.4)ml, t=1.473, P=0.128]、253组淋巴结清扫数量[(3.8±1.5)和(4.2±1.6), t=0.785, P=0.221]、淋巴结清扫总数[(14.1±4.3)和(15.8±5.0), t=1.652, P=0.113]差异均无统计学意义。两组间吻合口出血发生率[4.4%(4/90)和3.8%(3/78)χ^(2)=1.182, P=0.133]和尿潴留发生率[4.4%(4/90)和6.4%(5/78), χ^(2)=1.785, P=0.148]差异无统计学意义;保留LCA组术后首次排气时间[(52.4±23.2)h和(68.3±29.3)h, t=2.652, P=0.023], 术后住院时间[(9.07±3.56)d和(10.68±4.94)d, t=2.785, P=0.017]短于不保留LCA组, 保留LCA组和不保留LAC组吻合口漏发生率分别为[2.2%(2/90)和5.1%(4/78)], 有统计学差异(t=3.575, P=0.001)。结论腹腔镜直肠癌根治术中保留LCA在老年直肠癌患者中是安全可行, 而且可以降低吻合口漏发生率、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 evaluate the short-term efficacy of left colonic artery preservation in laparoscopic-assisted radical resection in elderly patients with rectal cancer.Methods 168 patients aged 65 and over who had undergonelaparoscopic assisted radical resection of rectal cancer in the gastrointestinal surgery department of Beijing Hospital from December 2017 to Decermber 2020 were retrospectively analyzed.According to different surgical methods,they were divided into the observation group with 90 subjects(the LCA group)and the control group with 78 subjects(the non-LCA group).Basic data,intraoperative,postoperative and clinicopathological data of the two groups were compared and analyzed.Results There were no statistically significant differences between the two groups in operative time[(172.3±35.5)min us。(155.5±28.7)min,t=2.182.P=0.103],intraoperative blood loss[(72.6±22.5)ml us.(67.3±18.4)ml,t=1.473,P=0.128],number of group 253 lymph nodes discted[(3.8±1.5)us.(4.2±1.6),t=0.785.P=0.221],and total number of lymph nodes dsscted[(14.1±4.3)us.(15.8±5.0).t=1.652.P=0.113].There was no significant difference in the incidence of anastomotic hemorrhage[4.4%(4/90)vs.3.8%(3/78),χ^(2)=1.182,P=0.133]and the ineidence of urinary retention[4.4%(4/90)vs.6.4%(5/78),χ^(2)=1.785,P=0.148].The time to first postoperative flatus[(52.4±23.2)h us.(68.3±29.3)h,t=2.652,P=0.023]and length of postoperative hospital stay[(9.07±3.56)d us.(10.68±4.94)d,t=2.785,P=0.017]in the LCA group were shorter than those in the non-LCA group.The incidences of anas tomotic leakage in the LCA group and the non-LAC group were 2.2%(2/90)and 5.1%(4/78),respectively,and the difference was statistically significant(t=3.575,P=0.001).Conclusions LCA preservation in laparoscopic-assisted radical resection of rectal cancer in elderly patients with rectal cancer is safe and feasible,reduces the incidence of anastomotic leakage,and shorten the time to first postoperative flatus and length of postoperative hospital stay.It has good practical clinical value

关 键 词：直肠癌 左结肠动脉 

分 类 号：R735.37[医药卫生—肿瘤]