左结肠动脉保留预防中低位直肠癌术后吻合口狭窄的临床疗效

目的:评估中低位直肠癌术中左结肠动脉保留预防术后吻合口狭窄的临床价值。方法:选择2017年1月至2018年12月在大连大学附属新华医院行腹腔镜Dixon术的60例中低位直肠癌患者,根据入院顺序分为左结肠动脉非保留组和左结肠动脉保留组各30例。2组均行肠系膜血管CT造影(CTA),明确肠系膜下动脉(IMA)分型和Riolan动脉弓是否缺如,并分析IMA分型和Riolan动脉弓缺如对术后吻合口狭窄的影响。结果:60例中低位直肠癌患者中,IMA-Ⅰ型31例(51.7%),IMA-Ⅱ型6例(10.0%),IMA-Ⅲ型23例(38.3%),无IMA-Ⅳ型;Riolan动脉弓缺如41例(68.3%)。保留组术后吻合口狭窄的发生率(10.0%)低于非保留组(33.3%,P=0.028)。2组IMA-Ⅰ、IMA-Ⅱ型患者,无论Riolan动脉弓缺如与否,均未发生术后吻合口狭窄;非保留组中,Riolan动脉弓缺如和IMA-Ⅲ型患者多发生术后吻合口狭窄(9/10)。结论:左结肠动脉保留对中低位直肠癌术后吻合口狭窄的预防至关重要,尤其可降低Riolan动脉弓缺如合并IMA-Ⅲ型患者术后吻合口狭窄的发生率。

Clinical value of preservation of left colonic artery to the postoperative anastomotic stenosis of mid and low rectal cancer

Objective:To evaluate the clinical value of preserving left colonic artery in preventing the anastomotic stenosis after operation of middle and low rectal cancer.Methods:Sixty patients with mid and low rectal cancer and underwent laparoscopic resection(Dixon)in Xinhua Hospital Affiliated to Dalian University from January 2017 to December 2018 were selected.The patients were divided into the preserved left colonic artery group(preserved group)and excised left colonic artery group(excised group),with 30 patients in each group.CT angiography(CTA)was used to examined the types of inferior mesenteric artery(IMA).And the influences of IMA types and Riolan artery arcade absence on the postoperative anastomotic stenosis were analyzed.Results:Among the sixty patients,the proportion of IMA-Ⅰ,-Ⅱ,and-Ⅲtypes were 51.7%(31/60),10.0%(6/60),and 38.3%(23/60),respectively,and no one with IMA-Ⅳ.The proportion of Riolan artery arcade absence was 68.3%(41/60).The postoperative anastomotic stenosis rate in the preserved group(10.0%)was lower than that in the excised group(33.3%,P=0.028).In the two groups,no patient with IMA-Ⅰ,-Ⅱhad the postoperative anastomotic stenosis regardless of the presence of Riolan artery arcade absence.In the excised group,the postoperative anastomotic stenosis occurred in majority of patients with Riolan artery arcade absence and IMA-Ⅲtype(9/10).Conclusions:The preservation of left colonic artery is crucial to prevent the postoperative anastomotic stenosis of middle and low rectal cancer,especially in patients with Riolan artery arcade absence and IMA-Ⅲtype.