保留左结肠动脉的腹腔镜直肠癌前切除术的临床体会

目的:探讨保留左结肠动脉的腹腔镜直肠癌前切除术(Dixon)的可行性及应用价值。方法:回顾分析2010~2013年47例直肠癌患者行腹腔镜手术的临床资料,将患者随机分为两组,25例行传统腹腔镜直肠癌根治术(传统组),22例行保留左结肠动脉的腹腔镜直肠癌前切除术(研究组)。对比分析两组手术时间、术中出血量、淋巴结清扫情况、术后局部复发及吻合口漏的发生情况。结果:47例手术均获成功。两组手术时间、术中出血量差异有统计学意义(P<0.05),清扫淋巴结数量差异统计学意义。两组患者术中均无直肠破裂穿孔,血管、输尿管及邻近器官损伤,吻合口无张力。术后传统组发生吻合口漏1例。术后随访无淋巴结转移。结论:对于临床分期Ⅰ~Ⅲ期的直肠癌患者,腹腔镜手术可清晰解剖肠系膜下动脉各分支,在不影响肠系膜下动脉周围淋巴结清扫的基础上,行保留左结肠动脉的Dixon术保证了吻合口的血运,降低了吻合口张力,从而降低了吻合口漏的发生率。

Clinical experience of laparoscopic anterior resection of rectal carcinoma with preservation of the left colonic artery

Objective：To evaluate the feasibility and efficacy of laparoscopic anterior resection of rectal carcinoma （Dixon） with preservation of the left colonic artery. Methods：From 2010 to 2013,47 patients with rectal carcinoma formerly scheduled for lapa-roscopic Dixon operation （ clinical stage Ⅰ , Ⅱ and Ⅲ ） received laparoscopic Dixon surgery with preservation of the left colonic artery （ n = 22 ） or conventional laparoscopic Dixon surgery （ n = 25 ）. The operation time, blood loss, number of harvested lymph node, postop- erative local recurrence,lymph node metastasis and the incidence of anastomotic fistula were comparatively analyzed. Results：The 47 operations were successfully completed. There were significantly statistical differences in operative time and intraoperative blood loss be-tween the 2 groups （ P 〈 0.05 ）, but no differences in harvested lymph nodes. No intraoperative rectal rupture or perforation, no injury of blood vessels, ureter and adjacent organs were found. The anastomotic stoma had no tension. One case of postoperative anastomotic leak- age occurred in conventional surgery group. During postoperative follow-up, no lymph node metastasis occurred. Conclusions： Laparo- scopic anterior resection of the rectal carcinoma with preservation of the left colonic artery can be completed in patients with rectal carci- noma planning to receive Dixon operation （ clinical stage I , II and m ）. In this surgical approach surgeons can clearly anatomize vari-ous branches of inferior mesenteric artery,preserve more supplying vessels and prevent anastomotic leakage without increasing the anas-tomotic tension or affecting lymph node dissection surrounding the inferior mesenterie artery.