腹腔镜下保留左结肠动脉直肠癌根治术的临床研究

目的 探讨保留左结肠动脉(LCA)并行第253组淋巴结清扫对腹腔镜直肠癌根治术手术安全性和疗效的影响.方法 选取2017年4月-2021年2月六安市人民医院结直肠外科80例腹腔镜直肠癌根治术患者,按随机数字表法分为观察组和对照组各40例.观察组给予保留LCA,并清扫第253组淋巴结.对照组不保留LCA,于肠系膜下动脉根...

Clinical study of laparoscopic radical resection of rectal cancer with preservation of left colonic artery dissection

  Objective  To evaluate the safety and efficacy of laparoscopic radical resection of rectal cancer with left colonic artery (LCA) preservation and group 253 (253rd group) lymph node dissection.  Methods  From April 2017 to February 2021, 80 patients who underwent laparoscopic radical resection of rectal cancer in the Colorectal Surgery Department of Lu'an People's Hospital were selected and randomly divided into the observation group and control group (40 cases in each group). The observation group was given LCA preservation, and the 253rd group lymph nodes were cleaned. In the control group, LCA was not retained, but the inferior mesenteric artery was severed. The intraoperative and postoperative conditions of both groups were compared.  Results  Intraoperative conditions: the pressures of colonic marginal artery arch in the observation group and the control group were (47.00±9.02) mm Hg (1 mm Hg=0.133 kPa) and (37.40±7.52) mm Hg, respectively. The difference between the two groups was statistically significant (P < 0.05). In the observation group, LCA was temporarily clamped during operation, and the pressure of colonic marginal artery arch was (36.00±8.37) mm Hg. The difference before and after clipping was statistically significant (P < 0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in operation time, intraoperative blood loss, number of lymph nodes removed in 253rd group lymph node dissection and mesenteric lymph node dissection between the two groups (all P>0.05). There was significant difference in free spleen curvature and preventive stoma rate between the two groups (all P < 0.05). Postoperative situation: there were significant differences in the incidence of anastomotic leakage and the first anal exhaust time between the two groups (all P < 0.05).  Conclusion  Preserving LCA and 253rd group lymph node dissection can ensure thorough dissection without increasing complications, significantly increase the pressure of proximal colonic artery arch, reduce the rate of ileostomy prevention and splenic flexure dissociation, and reduce the incidence of postoperative anastomotic leakage. It is a safe and reliable operation.