保留左结肠动脉的腹腔镜直肠癌D3根治术对中晚期直肠癌患者的临床效果分析

目的探讨保留左结肠动脉的腹腔镜直肠癌D3根治术(Dixon)对中晚期直肠癌患者的临床效果分析。方法选取2015年12月至2018年1月60例中晚期直肠癌患者资料,根据术式不同分为保留组和未保留组,其中保留组(n=32)采用保留左结肠动脉的Dixon术,未保留组(n=28)采用高位结扎的Dixon术。采用SPSS 22.00软件对数据资料进行处理,围术期各项指标用(x±s)表示,采用独立t检验;术后并发症发生率、淋巴结清扫情况采用χ^2或Fisher检验,P<0.05表示差异有统计学意义。结果保留组肛门排气时间、边缘动脉弓压力显著少于未保留组(P<0.05),其余围术期指标比较均无统计学意义(P>0.05);两组清扫淋巴总数、转移淋巴结数及阳性淋巴结总数差异均无统计学意义(P>0.05),但保留组清扫第253组淋巴结数目显著大于未保留组(P<0.05);保留组吻合口漏发生率3.1%(1/32)显著少于未保留组10.7%(3/28),(P<0.05);两组患者术后1年肿瘤复发、转移发生率差异无统计学意义(P<0.05)。结论相比于高位结扎的Dixon术,保留左结肠动脉不增加术后肿瘤复发转移概率,并且可有效降低吻合口漏的发生率,具有良好的应用前景。

Clinical effect of laparoscopic rectal cancer D3 radical surgery with left colon artery preservation for patients with advanced colorectal cancer

Objective To investigate the clinical effect of laparoscopic rectal cancer D3 radical surgery with left colon artery for patients with advanced colorectal cancer.Methods From December 2015 to January 2018,clinical data of 60 patients with advanced colorectal cancer were analyzed retrospectively,who were divided into the reserved group and the unreserved group according to the different surgical procedures.Patients in the reserved group(n=32)underwent laparoscopic rectal cancer D3 radical operation with preservation of left colon artery,while high-ligation of IMA was performed in the unreserved group(n=28).SPSS 22.0 software were used for statistical analysis.Measurement data such as the perioperative index,number of harvested lymph nodes were expressed as (x±s) and were analyzed by using independent sample t test.Count data such as complication rate were expressed as percentage and were analyzed by usingχ^2 test or Fisher’s test.A P value of<0.05 was considered as statistically significant difference.Results The anal exhaust time and marginal arch pressure in the reserved group were significantly less than those in the unreserved group respectively(P<0.05),while in terms of the other perioperative indicators there were no significant difference(P>0.05).There was no statistically significant difference between two groups in terms of number of harvested lymph nodes and positive lymph nodes(P>0.05),however the number of 253 lymph nodes in the reserved group was significantly more than that in the unreserved group(P<0.05).The incidence of anastomotic leakage of 3.1%(1/32)in the reserved group was significantly less than 10.7%(3/28)in the unreserved group(P<0.05).There was no statistically significant difference between the two groups in terms of incidence of recurrence and metastasis at 1 year after operation(P<0.05).Conclusion Compared with high-ligation of IMA in laparoscopic D3 radical surgery,preserving the left colon artery does not increase postoperative tumor recurrence and metastasis,and could effectively reduce the incidence of anastomotic leakage.It has good prospects.