MSCTA在保留LCA腹腔镜直肠癌根治术中的临床应用研究  

Clinical Application of MSCTA in Laparoscopic Radical Resection of Rectal Cancer with LCA Preserved

作　　者：周海华[1] 李迎春[1] 王小冬[1] 韩宁 潘琳琳 于晨 ZHOU Hai-hua;LI Ying-chun;WANG Xiao-dong;HAN Ning;PAN Lin-lin;YU Chen(Taizhou People's Hospital,Taizhou Jiangsu 225300,China)

机构地区：[1]泰州市人民医院,江苏泰州225300

出　　处：《泰州职业技术学院学报》2022年第2期59-63,共5页Journal of Taizhou Polytechnic College

摘　　要：目的探讨多层螺旋CT血管成像(MSCTA)在保留左结肠动脉(LCA)的腹腔镜直肠癌根治术中的临床应用价值。方法回顾性分析2018年1月至2019年12月在本院行保留LCA腹腔镜直肠癌根治术的直肠癌患者130例,根据术前是否利用MSCTA技术进行IMA成像分为观察组60例和对照组70例。比较两组患者相关指标,评价MSCTA技术在保留LCA腹腔镜直肠癌根治术中的临床应用价值。结果所有手术均顺利完成,无围手术期死亡病例。LCA保留成功率观察组83.3%,对照组14.3%;平均手术时间观察组为109.2±13.24 min,对照组为141.5±17.56 min;术中出血量观察组为10.5±8.67 ml,对照组为24.3±15.21 ml;术后排气时间观察组平均为33.8±9.95 h,对照组平均为41.0±17.14 h;术后住院时间观察组平均为9.3±1.42 d,对照组平均为13.2±4.38 d;观察组吻合口并发症发生率为1.7%,对照组为5.71%,差异均具有统计学意义(P均<0.05)。观察组淋巴结清扫数目为16.5±3.79枚,对照组为17.1±4.86枚;观察组术后排尿功能障碍发生率6.7%(4/60),对照组为8.6%(6/70);观察组性功能障碍发生率16.7%(10/60),对照组为21.4%(15/70);术后随访25个月(6~42个月),随访期间观察组肿瘤转移发生率为1.7%(1/60),对照组为2.9%(2/70),差异均无统计学意义(P均>0.05)。结论术前应用MSCTA技术进行IMA三维成像,便于术前准确评估IMA的分型及解剖定位,减少术中LCA损伤及出血,提高LCA保留成功率,缩短手术时间,且降低了吻合口并发症的发生率。Objective To explore the clinical application of multi-slice spiral CT angiography(MSCTA)in laparoscopic radical resection of rectal cancer with left colon artery(LCA)preserved.Methods The clinical data of 130 patients with rectal cancer undergoing Laparoscopic radical resection of rectal cancer from January 2018 to December 2019 in the Department of Anorectal of the Taizhou People's Hospital were retrospectively analyzed.According to whether or not to use MSCTA technology for IMA imaging before operation,the patients were divided into observation group(60 cases)and control group(70 cases).To compare the related indexes of two groups of patients and evaluate the clinical application value of MSCTA technique in laparoscopic radical resection of rectal cancer with LCA preserved.Results All the operations were successfully completed and there were no perioperative deaths.The observation group is obviously superior to the control group in terms of the retention rate of LCA[(83.3%)vs(14.3%)],operation time[(109.2±13.24min)vs(141.5±17.56min)],intraoperative blood loss[(10.5±8.67ml)vs(24.3±15.21ml)],postoperative intestinal function recovery[(33.8±9.95h)vs(41.0±17.14h)],incidence of anastomotic complications[(2%)vs(13.3%)]and postoperative hospital stay[(9.3±1.42d)vs(13.2±4.38d)],all the difference was statistically significant(P<0.05).There was no significant difference in the number of lymph node dissection[(16.5±3.79)vs(17.1±4.86)],tumor metastasis[(1.7%)vs(2.9%)],incidence of postoperative urinary dysfunction[(6.7%)vs(8.6%)]and sexual dysfunction[(16.7%)vs(21.4%)]between the two groups(P>0.05).Conclusion The application of MSCTA technology in IMA imaging before operation is convenient for accurate evaluation of IMA classification and anatomical location before operation,which can significantly reduce LCA injury and bleeding during operation,improving LCA retention success rate,shortening operation time and reducing the incidence of anastomotic complications.

关 键 词：直肠癌 肠系膜下动脉 左结肠动脉 多层螺旋CT血管成像 直肠全系膜切除术 

分 类 号：R735.37[医药卫生—肿瘤]