腹腔镜下左半结肠切除术中切除肠系膜下动脉主干的近期疗效观察  

Short Term Effect of Resection of the Main Trunk of the Inferior Mesenteric Artery during Laparoscopic Left Hemicolectomy

作　　者：宋宗工 姚毅明 周学伟[1] SONG Zong-gong;YAO Yi-ming;ZHOU Xue-wei(Minimally Invasive Surgery,Nanyang Second People’s Hospital,Nanyang,Henan,473000,China)

机构地区：[1]南阳市第二人民医院微创外科,河南南阳473000

出　　处：《黑龙江医学》2023年第3期290-293,共4页Heilongjiang Medical Journal

摘　　要：目的:观察腹腔镜辅助左半结肠切除术中切除肠系膜下动脉(inferior mesenteric artery,IMA)主干的近期疗效。方法:选取2018年2月—2021年2月南阳市第二人民医院就诊的94例行腹腔镜下左半结肠切除术的结肠癌患者作为研究对象,按随机数表法分为观察组(47例)与对照组(47例)。观察组在行腹腔镜左半结肠切除术时,保留左结肠动脉(left colic artery,LCA)以及两支左右的乙状结肠动脉(sigmoid artery,SA),于远端离断肠系膜下动脉主干;对照组则解剖IMA主干,并清扫其周围淋巴结,分离出LCA与一支SA之后,于根部闭合离断LCA以及该SA。比较两组患者的手术情况、术后恢复情况及并发症发生率。结果:观察组患者手术时间短于对照组,术中出血量少于对照组,切除肠管长度大于对照组,差异有统计学意义(t=5.065、7.174、2.436,P<0.05),淋巴结清扫数目无明显差异,差异无统计学意义(t=0.443,P>0.05);观察组术后首次排气时间短于对照组,胃肠道功能恢复时间、引流管拔除时间早于对照组,住院时间短于对照组,差异有统计学意义(t=3.548、2.674、2.763、3.571,P<0.05);术后30 d两组患者的并发症发生情况无明显差异,差异无统计学意义(χ^(2)=0.123,P>0.05)。结论:腔镜辅助下左半结肠切除术中切除IMA主干的近期疗效优于保留IMA主干,术中出血量较少,手术时间较短,切除可疑肠管的长度增加,术后恢复较快。Objective:To observe the recent efficacy of resection of the inferior mesenteric artery(IMA) trunk during laparoscopic-assisted left hemicolectomy.Methods:94 colon cancer patients with laparoscopic left hemicolectomy attending the hospital from February 2018 to February 2021 were selected as the study population and divided into observation and control groups according to the random number table method, with 47 cases in each group. In the observation group, the left colic artery(LCA) and two left and right sigmoid arteries(SA) were preserved during laparoscopic left hemicolectomy, and the main trunk of the inferior mesenteric artery was disconnected distally. In the control group, the IMA trunk was dissected and the surrounding lymph nodes were cleared,and after separating the LCA and an SA, the LCA and the SA were dissected at the root closure. The surgical conditions, postoperative recovery and complication rates of the two groups were compared.Results:The operating time of the observation group was shorter than that of the control group, the intraoperative bleeding was less than that of the control group, and the length of the resected intestinal tube was greater than that of the control group, with statistically significant differences(t=5.065, 7.174, 2.436,P<0.05). There was no significant difference in the number of lymph nodes cleared, and the difference was not statistically significant(t=0.443, P>0.05). In the observation group, the time of first postoperative venting was shorter than that in the control group,the time of recovery of gastrointestinal function and drainage tube removal was earlier than that in the control group, and the hospital stay was shorter than that in the control group, with statistically significant differences(t=3.548, 2.674, 2.763, 3.571, P<0.05).There was no significant difference in the occurrence of complications between the two groups at 30 d postoperatively, and the difference was not statistically significant(χ^(2)=0.123, P>0.05).Conclusion:The short-term outcome of lumpe

关 键 词：腹腔镜 左半结肠切除术 结肠癌 肠系膜下动脉 近期疗效 

分 类 号：R735.35[医药卫生—肿瘤]