腹腔镜直肠癌根治术中保留左结肠动脉可行性的研究

摘要

Objective: To explore the feasibility of preserving Left colic artery (LCA) in laparoscopic radical resection of rectal cancer. Methods:The clinical data of 102 cases of laparoscopic rectal radical resec-tion admitted in our hospital from July 2014 to January 2017 were retrospectively analyzed,including 36 cases with preservation of LCA (the experimental group)and 66 cases without preservation of LCA(the control group). Through comparing the operative time,blood loss,postoperative exhaust time,pull out time of pelvic drainage tube,the number of lymph nodes removed around the root of inferior mesenteric artery, to get the difference in the surgical outcome between the two groups.Results:No significant difference was found in intr-aoperative blood loss [65 (20-300) vs 70 (10-400) ml, p=0.848], operative time [165 (104-270) vs 183 (100-328) min,p=0.368],pull out time of pelvic drainage tube[12.5 (6-44) vs 13 (7-120),p=0. 220],postoperative exhaust time[6(2-12) vs 6(2-18),p=0.253],the number of lymph nodes removed around the root of IMA [15.694±2.745 vs 16.288±3.262,p=0.356]between the two groups. 2 cases of anas-tomotic leakage occurred in the preservation group,while 14 cases of anastomotic leakage occurred in the none-preservation group(p=0.038),there was statistical difference between the two groups(P<0.05),it can be proved that the experimental group can effectively reduce the occurrence of anastomotic leakage. Conclusion:The operation of preserving the left colonic artery in laparoscopic radical resection of rectal cancer reduce the incidence of anastomotic leakage and don't increase the risk of operation. It is a safe and feasible operation.%目的:探讨腹腔镜直肠癌根治术中保留左结肠动脉(Left colic artery,LCA)的可行性.方法:回顾性统计2014年7月至2017年1月行腹腔镜下直肠癌根治术的患者共102例,其中保留左结肠动脉患者共36例(保留组),不保留结肠动脉的患者共66例(未保留组).通过比较保留组和未保留组之间的术中失血量、手术时间、术后排气时间、盆腔引流管拔出时间、肠系膜下动脉(Inferior mesenteric artery, IMA)根部淋巴结清扫数目、术后吻合口瘘的发生率,得到两组之间手术效果的差异.结果:保留组对未保留组,在术中失血量[65(20~300)vs70(10~400)mL,P=0.848]、手术时间[165(104~270) vs183(100~328)min,P=0.368]、术后排气时间[6(2~12)vs6(2~18),P=0.253]、盆腔引流管拔出时间[12.5(6~44)vs13(7~120),P=0.220]、肠系膜下动脉根部淋巴结清扫数目[15.694±2.745vs16.288±3. 262,P=0.356]方面,保留组与未保留组无统计差异(P>0.05).保留组术后出现2例吻合口瘘,未保留组术后有14例吻合口瘘出现(P=0.038),两组之间有统计学差异(P<0.05),证明保留组能有效降低吻合口瘘的发生.结论:在腹腔镜直肠癌根治术中保留左结肠动脉没有增加手术风险,并降低吻合口瘘发生率,是安全可行的术式.