保留左结肠动脉在腹腔镜直肠癌根治术中的临床价值  

Clinical value of left colon artery prevention in laparoscopic radical resection of rectal cancer

作　　者：叶甫波[1] 朱雄文[1] 吴贵阳[1] 刘翰林[1] 袁世超[1] 范庆豪 YE Fubo;ZHU Xiongwen;WU Guiyang;LIU Hanlin;YUAN Shichao;FAN Qinghao(Department of Gastrointestinal and Anorectal Surgery,Taizhou Municipal Hospital,Taizhou 318000,China)

机构地区：[1]台州市立医院胃肠肛肠外科,浙江台州318000

出　　处：《中国现代医生》2022年第11期64-68,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2020KY1046);浙江省台州市科技计划项目(1801ky51)。

摘　　要：目的研究腹腔镜直肠癌根治术中保留左结肠动脉的临床价值。方法选择2016年1月至2020年1月台州市立医院胃肠肛肠外科收治的140例直肠癌患者的临床资料进行回顾性分析。所有患者均采用腹腔镜直肠癌D3根治术,其中68例采用低位结扎肠系膜下动脉(保留左结肠动脉组),72例采用高位结扎肠系膜下动脉(不保留左结肠动脉组)。对两组患者的手术时间、术中出血量、淋巴结清扫数、回肠造口率、术后肛门首次排气时间、住院时间、并发症情况进行比较。结果保留左结肠动脉组的手术时间长于不保留左结肠动脉组,但差异无统计学意义(P>0.05);保留左结肠动脉组患者术后肛门排气时间短于不保留LCA组,但差异无统计学意义(P>0.05);两组患者清扫总淋巴结数、第三站淋巴结数、住院时间及术中出血量比较,差异无统计学意义(P>0.05);两组患者行回肠预防性造口率分别为7.35%(5/68)和19.44%(14/72),差异有统计学意义(P<O.05);两组患者(未行回肠造口)吻合口瘘发生率分别为4.76%(3/63)和15.52%(9/58),差异有统计学意义(P<O.05);并发症总发生率分别为12.70%(8/63)和24.14%(14/58),差异无统计学意义(P>O.05)。结论腹腔镜下保留左结肠动脉的直肠癌根治手术对淋巴结清扫不会产生影响,可减少回肠预防性造口率及吻合口瘘发生率,值得在临床推广应用。Objective To study the clinical value of left colon artery preservation in laparoscopic radical resection of rectal cancer.Methods A retrospective analysis of clinical data of 140 patients with rectal cancer admitted to the Department of Gastroenterology and Anorectal Surgery of Taizhou Municipal Hospital from January 2016 to January 2020 was conducted.All patients underwent laparoscopic D3 radical resection of rectal cancer.Among them,68 patients were given low ligation of inferior mesenteric artery(the left colon artery preservation group),and 72 patients were given high ligation of inferior mesenteric artery(the left colon artery non-preservation group).The operation time,intraoperative blood loss,number of lymph node dissections,ileostomy incidence,first postoperative anus exhaust time,hospital stay,and complications were compared between the two groups.Results The operation time in the left colon artery preservation group was longer than that in the non-preservation group,without statistically significant difference(P>0.05).The postoperative anal exhaust time in the left colon artery preservation group was shorter than that in the non-preservation group,without statistically significant difference(P>0.05).There were no significant differences in total number of lymph nodes dissections,number of lymph nodes in the third station,hospital stay and intraoperative blood loss between the two groups(P>0.05).The incidence of preventive ileostomy was 7.35%(5/68)and 19.44%(14/72)in the two groups,respectively,with statistically significant difference(P<0.05).The incidence of anastomotic leakage was 4.76%(3/63)and 15.52%(9/58)in the two groups(without ileostomy),with statistically significant difference(P<0.05).The total incidence of complications was 12.70%(8/63)and 24.14%(14/58)in the two groups,respectively,without statistically significant difference(P>0.05).Conclusion Laparoscopic radical resection of rectal cancer with left colon artery preservation will not affect lymph node dissection and can reduce incidences

关 键 词：直肠癌 腹腔镜 左结肠动脉 吻合口瘘 

分 类 号：R735.2[医药卫生—肿瘤]