腹腔镜下直肠癌前切除术中保留左结肠动脉的意义

目的探讨腹腔镜下直肠癌前切除手术中保留左结肠动脉(left colonic artery,LCA)的可操作性及近期疗效。方法回顾性分析武汉科技大学附属孝感医院收治的129例实施腹腔镜直肠癌前切除术病人的临床资料,根据术中是否保留LCA分为保留LCA组(51例)和不保留LCA组(78例),比较两组病人术中、术后情况的变化。结果两组病人在术中出血量、分离脾区数、清扫第253组淋巴结数、预防性造瘘数、吻合口漏发生率等方面差异均无统计学意义(均P>0.05)。保留LCA组手术时间长于不保留LCA组,差异有统计学意义(P<0.05);保留LCA组术后肛门首次排气时间短于不保留LCA组,差异有统计学意义(P<0.05)。结论腹腔镜直肠癌手术中保留LCA不影响肠系膜下动脉根部淋巴结清扫,可降低吻合口漏发生的风险和减少术后通气时间,有临床应用价值。

Clinical application value of preserving left colonic artery during laparoscopic radical resection of rectal cancer

Objective To study the operability and short-term efficacy of preserving left colonic artery(LCA)during laparoscopic radical resection of rectal cancer.Methods The clinical data of 129 patients who underwent laparoscopic anterior resection of rectal cancer in Xiaogan Hospital affiliated to Wuhan University of Science and Technology were analyzed retrospectively.The patients were divided into LCA group(51 cases)and non-LCA group(78 cases).The clinical conditions during operation and after operation were compared between two groups.Results There was no significant difference between the two groups(P>0.05)in the amount of blood loss,the number of splenic areas separated,the number of lymph nodes dissected in group 253,the number of prophylactic fistulas and the incidence of anastomotic leakage.The operative time of LCA retaining group was longer than that of the LCA non-retaining group,and the difference was statistically significant(P<0.05),and the time of first exsufflation in LCA retaining group was shorter than the LCA non-retaining group.The difference was statistically significant(P<0.05).Conclusion The preservation of left colic artery in laparoscopic rectal cancer surgery does not affect the lymph node dissection at the root of inferior mesenteric artery,which can reduce the risk of anastomotic leakage and reduce postoperative ventilation time.It has potential for clinical application.