保留左结肠动脉的肠系膜下动脉根部淋巴结清扫对腹腔镜直肠癌根治术的疗效影响  

Effect of left colic artery-preserving lymph node dissection at the root of the inferior mesenteric artery

作　　者：刘福成[1] 赵欣[1] 乔海朋[1] 刘晓峰 张翀 张宗明 Liu Fucheng;Zhao Xin;Qiao Haipeng;Liu Xiaofeng;Zhang Chong;Zhang Zongming(Department of General Surgery,Beijing Fengtai Hospital,Beijing 100071,China;Department of General Surgery,Beijing Electric Power Hospital,State Grid Corporation,Beijing 100073,China;Key Laboratory of Gerontology(Hepatobiliary),China General Technology Group,Beijing 100073,China)

机构地区：[1]北京丰台医院普外科,北京100071 [2]国家电网公司北京电力医院普外科,北京100073 [3]中国通用技术集团老年医学(肝胆)重点实验室,北京100073

出　　处：《中华临床医师杂志(电子版)》2024年第7期647-653,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：北京丰台医院科研项目(2022-18);北京市科技重大专项生物医药与生命科学创新培育研究(Z171100000417056);国中康健集团科技项目(GZKJ-KJXX-QTHT-20230626)

摘　　要：目的探讨保留左结肠动脉(LCA)的肠系膜下动脉(IMA)根部淋巴结清扫对腹腔镜直肠癌根治术的疗效影响。方法回顾性分析2017年2月至2019年2月北京丰台医院普通外科行腹腔镜直肠癌根治术患者的临床资料,根据IMA结扎位置分为高位结扎组(H组,IMA根部结扎)23例和低位结扎组(L组,保留LCA)74例,比较2组患者的手术效果(手术时间、术中出血量、淋巴结清扫数量、淋巴结转移数量、术后住院时间、术后肠功能恢复时间)、术后并发症、术后2年复发率和5年生存率。结果术前TNM分期2组患者无统计学差别,手术效果除术后肠功能恢复时间L组短于H组(P<0.05)外其余无统计学差别,术后吻合口漏、排尿功能障碍L组低于H组(P<0.05),术后2年复发率和5年生存率2组无统计学差别。结论保留LCA的IMA根部淋巴结清扫,在不影响腹腔镜直肠癌根治术疗效情况下,不仅可以缩短术后肠功能恢复时间,而且可以减少术后吻合口漏、排尿功能障碍并发症,值得推广应用。Objective To investigate the effect of left colic artery(LCA)-preserving lymph node dissection at the root of the inferior mesenteric artery(IMA)on the efficacy of laparoscopic radical resection of rectal cancer.Methods Clinical data of patients undergoing laparoscopic radical resection for rectal cancer at the Department of General Surgery of Beijing Fengtai Hospital from February 2017 to February 2019 were retrospectively analyzed.According to the location where the IMA was ligated,23 cases were included in a high ligation group(Group H,IMA root ligation)and 74 were included in a low ligation group(group L,LCA preserved).Operation parameters(operation time,intraoperative blood loss,number of lymph nodes dissected,number of metastatic lymph nodes,postoperative hospital stay,and time to postoperative intestinal function recovery),postoperative complications,and postoperative 2-year recurrence rate and 5-year survival rate were compared between the two groups.Results There was no statistical difference between the two groups in preoperative TNM stage.The time to postoperative intestinal function recovery was shorter in group L than in group H(P<0.05),but there was no statistical difference in the rest operation parameters.The incidence of postoperative anastomotic leakage and urinary dysfunction in group L was lower than that of group H(P<0.05).The postoperative 2-year recurrence rate and 5-year survival rate were not statistically different between the two groups.Conclusion LCA-preserving lymph node dissection at the root of the IMA can not only shorten the time to postoperative intestinal function recovery but also reduce the incidence of postoperative anastomotic leakage and urinary dysfunction without affecting the curative effect of laparoscopic radical resection for rectal cancer.

关 键 词：直肠癌 肠系膜下动脉 左结肠动脉 

分 类 号：R735.3[医药卫生—肿瘤]