中国实用外科杂志

中国实用外科杂志

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腹腔镜直肠癌手术中保留左结肠动脉与否疗效对比研究

骆    洋，秦    骏，陈建军，俞旻皓，秦绍岚，仇伊尔，钟    鸣   

  1. 上海交通大学医学院附属仁济医院胃肠外科，上海200127
  • 出版日期:2017-06-01 发布日期:2017-05-31

  • Online:2017-06-01 Published:2017-05-31

摘要：

目的    根据腹腔镜直肠癌手术中对于肠系膜下动脉处理方式的不同，探讨术中保留左结肠动脉的临床效果与应用价值。方法    回顾性分析上海交通大学医学院附属仁济医院2015年1月至2016年12月间523例腹腔镜直肠癌根治术的临床资料，分为低位结扎肠系膜下动脉组（低位结扎组）203例，高位结扎肠系膜下动脉组 （高位结扎组）320 例，比较两组病人术中情况、术后病理情况以及术后情况的变化。结果    低位结扎组与高位结扎组在病人年龄、性别、肿瘤大小、肿瘤侵犯肠壁深度、病理分型、分化程度、术中出血量、术后尿潴留发生率等方面差异均无统计学意义（P＞0.05）。但低位结扎组在术后首次通气时间、吻合口漏发生率以及术后3个月排便频次方面明显低于高位结扎组（P＜0.05）；在术中淋巴结收获数量方面低位结扎组较高位结扎组多（P＜0.05），但在整个手术时间上，低位结扎组却高于高位结扎组（P＜0.05）。 结论    保留左结肠动脉的腹腔镜直肠癌手术可以完成与高位结扎同样彻底的淋巴结清扫，并在一定程度上增加了淋巴结检出数目，降低了吻合口漏的发生率与术后首次通气时间，有临床推广价值。

关键词: 结直肠肿瘤, 左结肠动脉, 肠系膜下动脉, 低位结扎, 吻合口漏

Abstract:

Laparoscopic radical resection of rectal cancer with and without preservation of the left colonic artery：A comparative study        LUO Yang, QIN Jun, CHEN Jian-jun, et al．Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
Corresponding author：ZHONG Ming, E-mail: drzhongming1966@163.com
Abstract    Objective    To evaluate the clinical significance and value of  preserving left colic artery （LCA） when treating the inferior mesenteric artery （IMA） in laparoscopic resection for rectal cancer. Methods    The clinical data of 523 cases of rectal cancer performed laparoscopic resection of rectal cancer in Renji Hospital, Shanghai Jiaotong University School of Medicine from January 2015 to December 2016 were analyzed retrospectively. All the cases include 203 cases with preservation of LCA （low ligation group） and 320 cases without preservation of LCA （high ligation group）. The clinical conditions during operation and after operation were compared between two groups. Results    The difference was not significant statistically in age， sex， tumor size， depth of tumor invasion， histopathologic type，tumor differentiation， blood loss and urinary retention rate between two groups（P＞0.05）. The postoperative exhaust time, anastomotic leakage rate and defecation frequency 3 months  after  operation in low ligation group were lower than those in high ligation group（P＜0.05）. What’s more， the number of lymph node and operative time in low ligation group was more in high ligation group（P＜0.05）. Conclusion    Preservation of left colic artery in laparoscopic resection of rectal cancer can achieve radical clearance of lymph nodes， increase the number of lymph node detection， reduce the incidence of anastomotic leakage rate and postoperative exhaust time， which is worth clinical promotion.

Key words: colorectal cancer, left colic artery, inferior mesenteric artery, low ligation, anastomotic leakage