腹腔镜左半结肠癌根治术中采用IMA-CMA技术对淋巴结清扫的影响分析  

Effect of IMA-CMA Technique on Lymph Node Dissection during Laparo⁃scopic Radical Resection of Left Colon Cancer

作　　者：蒋骥霖 余修会 张宏 JIANG Jilin;YU Xiuhui;ZHANG Hong(Department of Gastrointestinal Surgery II,Nanping First Hospital Affiliated to Fujian Medical University,Nanping,Fujian Province,353000 China)

机构地区：[1]福建医科大学附属南平第一医院胃肠外科二区,福建南平353000

出　　处：《中外医疗》2024年第14期13-16,21,共5页China & Foreign Medical Treatment

摘　　要：目的 探讨腹腔镜左半结肠癌根治术中采用肠系膜下动脉优先解剖联合完全内侧入路(Priority Anatomy of the Inferior Mesenteric Artery Combined with Complete Medial Approach,IMA-CMA)技术对淋巴结清扫的影响。方法 回顾性选取2019年5月-2023年5月南平第一医院治疗的81例腹腔镜左半结肠癌根治术患者的临床资料,根据手术方法不同分为IMA-CMA组和对照组,其中IMA-CMA组44例,对照组37例。对照组采用传统入路技术,IMA-CMA组采用IMA-CMA技术,比较两组患者的手术相关指标、淋巴结清扫情况、术后肠功能恢复情况、并发症发生情况及复发率和转移率。结果 同对照组相比较,IMA-CMA组手术时间较短,术中出血量较低,253组淋巴结清扫数目较多,差异有统计学意义(P均<0.05)。同对照组相比较,IMA-CMA组腹痛腹胀持续时间、术后排便时间及术后排气时间均较短,差异有统计学意义(P均<0.05)。IMA-CMA组并发症发生率为4.55%,低于对照组的18.92%,差异有统计学意义(χ^(2)=4.204,P<0.05)。术后1年,IMA-CMA组和对照组复发率、转移率比较,差异无统计学意义(P均>0.05)。结论 腹腔镜左半结肠癌根治术中采用IMA-CMA技术能够缩短手术时间,减少术中出血量,对淋巴结的清扫情况更佳,且可以改善术后肠功能恢复情况及并发症发生情况,不增加复发和转移风险。Objective To investigate the effect of priority anatomy of the inferior mesenteric artery combined with com-plete medial approach(IMA-CMA)on lymph node dissection during laparoscopic radical resection of left colon can-cer.Methods Clinical data of 81 patients with laparoscopic radical resection of left colon cancer treated in Nanping First Hospital from May 2019 to May 2023 were retrospectively selected,and divided into IMA-CMA group and con-trol group according to different surgical methods,including 44 cases in IMA-CMA group and 37 cases in control group.The traditional approach technique was used in the control group and that in the IMA-CMA group.The surgi-cal indicators,lymph node dissection,postoperative intestinal function recovery,incidence of complications,recur-rence rate and metastasis rate were compared between the two groups.Results Compared with the control group,the operative time in the IMA-CMA group was shorter,the intraoperative blood loss in the IMA-CMA group was lower,and 253 lymph node dissection numbers in the IMA-CMA group was higher,and the differences were statistically sig-nificant(all P<0.05).Compared with the control group,the duration of abdominal pain and distension,postoperative defecation time and postoperative exhaust time in the IMA-CMA group were shorter,and the differences were statisti-cally significant(all P<0.05).The incidence of complications in the IMA-CMA group was 4.55%lower than that in the control group(18.92%),the difference was statistically significant(χ^(2)=4.204,P<0.05).One year after surgery,there was no significant difference in recurrence rate and metastasis rate between the IMA-CMA group and the con-trol group(both P>0.05).Conclusion The application of IMA-CMA technique in laparoscopic radical resection of left colon cancer can shorten the operation time,reduce intraoperative blood loss,better lymph node dissection,improve postoperative intestinal function recovery and complications,and do not increase the risk of recurrence and metastasis.

关 键 词：腹腔镜 左半结肠癌 肠系膜下动脉优先解剖 完全内测入路 淋巴结清扫 

分 类 号：R735[医药卫生—肿瘤]