不同手术入路在腹腔镜直肠癌前切除低位吻合术中的应用

目的研究经不同手术入路行保留左结肠动脉的腹腔镜直肠癌前切除低位吻合术的效果。方法回顾性分析我科2016年1月至2017年12月收治的80例行腹腔镜直肠癌前切除低位吻合术患者的临床资料,并按手术入路的不同分组,其中40例患者术中采取头侧中间入路,设为改良组;另外40例患者术中采取传统中间入路,设为传统组。比较2组患者手术时间、术中出血量、住院时间、术后并发症、左结肠后间隙打开时间、肠系膜下动脉周围淋巴结清扫时间、第253组淋巴结清扫数目、肿瘤下切缘距离、术后排气时间及远期预后情况,对比两种手术入路方式的临床效果。结果在手术时间、住院时间、术中出血量、肿瘤下切缘距离及术后排气时间方面,2组患者比较差异无统计学意义(P>0.05);而在肠系膜下动脉周围淋巴结清扫时间及第253组淋巴结清扫数目上,改良组优于传统组,差异有统计学意义(P<0.05);在术后并发症方面,改良组发生7例(17.50%),传统组发生8例(20.00%),2组比较差异无统计学意义(P>0.05)。结论采取头侧中间入路腹腔镜下直肠癌前切除低位吻合术治疗直肠癌患者,可有效缩短肠系膜下动脉周围淋巴结清扫时间,在第253组淋巴结清扫上较传统中间入路更具优势。

Application of different surgical approaches in laparoscopic low anastomosis for anterior resection of rectal cancer

Objective To analyze the effect of different surgical approaches in laparoscopic low anastomosis for anterior resection of rectal cancer with left colonic artery preservation.Methods Retrospective analysis was performed on the clinical data of 80 patients admitted into our department from January 2016 to December 2017 who underwent laparoscopic low anastomosis for anterior resection of rectal cancer.These patients were divided into the modified group(40 cases,cephalo-medial to lateral approach)and the conventional group(40 cases,traditional medial-to-lateral approach).The operation time,intraoperative bleeding volume,hospitalization time,postoperative complications,time to open the left Toldt space,time of lymph node dissected around the inferior mesenteric artery,number of D253 lymph node dissection,distance to distal resection margin,postoperative exhaust time and long-term prognosis were compared,so as to compare the the clinical effect of the two different approaches.Results The differences of operation time,hospitalization time,intraoperative bleeding volume,distance to distal resection margin,and postoperative exhaust time between the groups were not significantly different(P>0.05).The time of lymph node dissected around the inferior mesenteric artery and number of D253 lymph node dissection in the modified group were better than those of the conventional group,and the differences were statistically significant(P<0.05).There were 7 cases(17.50%)developed postoperative complication in the modified group and 8 cases(20.00%)in the conventional group,with no significant difference between the two groups(P>0.05).Conclusion During the laparoscopic low anastomosis for anterior resection of rectal cancer,the cephalo-medial to lateral approach could shorten the time of lymph node dissected around the inferior mesenteric artery,and it has more advantages in D253 lymph node dissection compared with the traditional medial-to-lateral approach.