不同入路保留左结肠动脉腹腔镜直肠癌根治术的临床对比  

Clinical comparison of laparoscopic radical resection of rectal cancer with preservation of left colonic artery through different approaches

作　　者：张宗涛 陈静静 夏永梅[1] 张保贵[1] 刘世祺 Zhang Zongtao;Chen Jingjing;Xia Yongmei;Zhang Baogui;Liu Shiqi(Department of Gastroenterology,Affiliated Hospital of Jining Medical College,Jining 276899,China)

机构地区：[1]济宁医学院附属医院胃肠外科,济宁276899

出　　处：《中国医师进修杂志》2025年第3期215-220,共6页Chinese Journal of Postgraduates of Medicine

基　　金：山东省自然科学基金(ZR2016HL30)。

摘　　要：目的比较不同入路(双侧入路、传统中间入路)保留左结肠动脉(LCA)的腹腔镜直肠癌根治术的应用效果。方法回顾性分析2021年1月至2023年12月济宁医学院附属医院收治的120例腹腔镜直肠癌根治术患者资料。依据保留LCA所选择的手术入路不同,将其中67例实施传统中间入路保留LCA患者纳入对照组,将其余53例实施双侧入路保留LCA患者纳入研究组。记录主要结局指标结果数据并比较组间差异,包括围手术期指标;淋巴结清扫情况;术前、术后2 d时胃肠激素[胃泌素(GAS)、胃动素(MOT)];术后吻合口出血、吻合口瘘、排尿功能障碍等并发症发生情况。结果与对照组比较,研究组手术时间长、术中出血量多[(132.68±11.24)min比(126.54±10.45)min、(78.41±5.35)ml比(75.22±5.10)ml],差异有统计学意义(P=0.003、0.001);而两组排气时间、住院时间及淋巴结总清扫数比较差异无统计学意义(P>0.05);但研究组253组淋巴结清扫数多于对照组[(5.18±1.26)个比(4.35±1.32)个],差异有统计学意义(P=0.001)。术后2 d,两组血清GAS、MOT均较术前降低,但两组比较差异无统计学意义(P>0.05)。研究组术后排尿功能障碍发生率低于对照组[0比10.45%(7/67)],差异有统计学意义(P=0.015)。结论较传统中间入路保留LCA的腹腔镜直肠癌根治术,双侧入路术式虽然手术时间长、术中出血略多,但能有效清扫253组淋巴结,减少术后排尿功能障碍发生。Objective To compare the application effects of different approaches(bilateral approach,traditional intermediate approach)in laparoscopic radical resection of rectal cancer with preservation of left colonic artery(LCA).Methods The data of 120 patients undergoing laparoscopic radical resection of rectal cancer from January 2021 to December 2023 were retrospectively analyzed.Based on the different surgical approaches chosen for preserving LCA,67 patients who underwent traditional intermediate approach to preserve LCA were included in the control group,while the remaining 53 patients who underwent bilateral approach to preserve LCA were included in the study group.The results of the main outcome indicators were recorded and the differences between the groups were compared,including perioperative indicators;lymph node dissection;gastrointestinal hormones(gastrin and motilin)before operation and 2 d after operation;postoperative complications such as anastomotic bleeding,anastomotic leakage,and urinary dysfunction.Results Compared with the control group,the study group had longer surgical time and more intraoperative bleeding:(132.68±11.24)min vs.(126.54±10.45)min,(78.41±5.35)ml vs.(75.22±5.10)ml,the difference was statistically significant(P=0.003 and 0.001).However,there was no significant difference in exhaust time and hospitalization time between the two groups(P>0.05).There was no significant difference in total lymph node clearance between the two groups(P>0.05).The number of lymph node dissection in the 253 groups of the study group was higher than that in the control group:(5.18±1.26)pieces vs.(4.35±1.32)pieces,the difference was statistically significant(P=0.001).On the second day after surgery,the serum gastrin and motilin in both groups decreased compared to before surgery,but there was no significant difference between the two groups(P>0.05).The incidence of postoperative urinary dysfunction in the study group was lower than that in the control group:0 vs.10.45%(7/67),the difference was statistically

关 键 词：直肠肿瘤 腹腔镜直肠癌根治术 直肠系膜切除 左结肠动脉 手术入路 

分 类 号：R735.37[医药卫生—肿瘤]