保留左结肠动脉在腹腔镜直肠癌根治术中的临床价值  

The Clinical Value of Left Colon Artery Preservation in Laparoscopic Radical Resection of Rectal Cancer

作　　者：国擎 GUO Qing(Department of General Surgery,Tiemei General Hospital of Liaoning Health Industry Group,Tieling 112700,China)

机构地区：[1]辽宁省健康产业集团铁煤总医院普通外科,辽宁铁岭112700

出　　处：《中国医药指南》2022年第15期87-89,93,共4页Guide of China Medicine

摘　　要：目的探究保留左结肠动脉在腹腔镜直肠癌根治术中的临床价值,为临床医师选择合理治疗方案提供参考。方法以2017年1月至2019年3月作为研究时段,选取在此期间在辽宁省健康产业集团铁煤总医院接受腹腔镜直肠癌根治术治疗患者,共81例,以其为研究样本,按照是否保留左结肠动脉为原则分组,不保留左结肠动脉患者为对照组(40例),保留左结肠动脉患者为试验组(41例),比较两组患者手术治疗情况、恢复情况和并发症发生情况。结果试验组手术时间、术中出血量、肿瘤直径、淋巴结清扫个数、IMA根部淋巴数量与对照组相比差异无统计学意义,P>0.05;试验组肛门首次排气时间、恢复自主排尿时间、进食时间、下床活动时间、住院时间与对照组相比差异无统计学意义,P>0.05;试验组吻合口瘘、游离脾曲、残端缺血性改变发生率均低于对照组,P<0.05,但腹腔感染、肠梗阻发生率、淋巴结感染率与对照组相比差异较小,无统计学意义,P>0.05。结论腹腔镜直肠癌根治术治疗中,保留左结肠动脉对手术操作、淋巴结清扫及术后恢复时间影响较小,可完整清除病灶淋巴结,以充分发挥其根治性特点,同时尽可能减少解剖结构变化,以提供上端吻合口更好血供,降低吻合口瘘等并发症发生率,更利于患者病情康复,伴随腹腔镜进一步发展,为安全、可行的手术方案。Objective To explore the clinical value of preserving the left colon artery in laparoscopic radical rectal cancer surgery,and to provide a reference for clinicians to choose a reasonable treatment plan.Methods The period from January 2017 to March 2019 was used as the research period.During this period,81 patients who underwent laparoscopic radical resection of rectal cancer at the Iron Tiemei General Hospital of Liaoning Health Industry Group were selected,and they were used as the research sample.According to the principle of whether to retain the left colon artery,40 cases were set as the control group without retention,and patients with preserved left colic artery were included in the experimental group(41 cases).The surgical treatment,recovery and complications of the two groups were compared.Results Compared with the control group,the operation time,intraoperative blood loss,tumor diameter,number of lymph nodes dissected,and number of lymph nodes at the root of IMA in the experimental group were not statistically different from those in the control group,P>0.05.There was no significant difference in the time of the first anal exhaust,the time to resume spontaneous urination,the time to eat,the time to get out of bed,and the length of hospital stay between the experimental group and the control group,P>0.05.The incidence of anastomotic leakage,free splenic flexure,and ischemic changes in the stump in the experimental group were lower than those in the control group,P<0.05,but the incidence of abdominal cavity infection,intestinal obstruction,and lymph node infection rate were small compared with the control group,and there was no statistical significance,P>0.05.Conclusion In the treatment of laparoscopic radical rectal cancer,retain the left colon artery has little effect on the operation,lymph node dissection and postoperative recovery time,and can completely remove the focal lymph nodes to give full play to its radical curative characteristics and minimize anatomical changes,In order to provide better bloo

关 键 词：腹腔镜 直肠癌根治术 保留左结肠动脉 吻合口瘘 临床效果 

分 类 号：R735.37[医药卫生—肿瘤]