保留左动脉与高位结扎用于腹腔镜直肠癌根治术的近中期随访比较

目的比较保留左动脉与高位结扎用于腹腔镜直肠癌根治术的近中期疗效。方法回顾性队列研究2015年12月至2019年12月79例腹腔镜直肠癌根治术患者临床资料,根据术中是否保留左结肠动脉分为保留组(n=41例,保留左结肠动脉)和结扎组(n=38例,高位结扎)。采用SPSS 23.0统计软件分析数据,围术期相关指标、吻合口边缘动脉血流情况以(x±s)表示,采用独立样本t检验;并发症、复发率等指标用χ²检验。P<0.05为差异有统计学意义。结果保留组患者术后排气时间、首次进食时间低于结扎组(P<0.05);保留组术后吻合口边缘动脉收缩期最大流速(PSV)、舒张末期流速(EDV)均比结扎组高(P<0.05)。保留组并发症总发生率(19.5%)与结扎组(23.7%)相比,差异无统计学意义(P>0.05),但保留组吻合口漏发生率低于结扎组(P<0.05)。两组患者术后2年局部复发率、转移率差异无统计学意义(P>0.05)。结论保留左结肠动脉可有效改善吻合口血供情况,减少术后吻合口漏发生风险,并可促进术后胃肠功能恢复。

Comparison of left artery preservation and high ligation for laparoscopic radical resection of rectal cancer in mid and late follow-up

Objective To compare the efficacy of left artery preservation and high ligation in laparoscopic radical resection of rectal cancer.Methods A retrospective cohort study of 79 patients with rectal cancer who underwent surgery from November 2015 to December 2019 was performed.The patients were divided into two groups according to whether the left colon artery was preserved during operation(n=41 cases,left colonic artery was preserved)and high ligation group(n-=38 high ligation).SPSS 23.0 statistical analysis software was used to analyze the data.Perioperative related indicators and blood flow of anastomotic margin artery were expressed as(x±s),independent t test was used.The complication and recurrence rate were tested by χ²test.P<0.05 was considered statistically significant.Results The postoperative exhaust time and first meal time in retention group were lower than those in ligation group(P<0.05).he maximum systolic flow rate(PSV)and end diastolic flow rate(EDV)of anastomotic margin artery in the retention group were higher than those in the ligation group(P<0.05),The total incidence of complications in the retention group(19.5%)was not statistically significant from that in the ligation group(23.7%)(P>0.05),but the incidence of anastomotic leakage in the retention group was lower than that in the ligation group(P<0.05).There was no significant difference in local recurrence rate and metastasis rate between the two groups after 2 years(P>0.05).Conclusion retention of the left colon artery can effectively improve the blood supply of anastomosis,reduce the risk of postoperative anastomotic leakage,and promote the recovery of postoperative gastrointestinal function.