腹腔镜直肠癌前切除术中左结肠动脉的处理方式对患者术后并发症的影响
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摘要
目的探究腹腔镜下直肠癌前切除术中左结肠动脉(LCA)的两种不同处理方式对患者术后并发症的影响。方法根据LCA处理方式的不同将150例行腹腔镜直肠癌前切除术的患者分为保留LCA组(n=85)和不保留LCA组(n=65)。对两组患者的手术相关指标及术后并发症发生情况进行比较。结果两组患者的术中出血量、手术时间、淋巴结清扫数目、253组淋巴结阳性例数比较,差异均无统计学意义(P﹥0.05);保留LCA组患者的术后首次排气时间明显短于不保留LCA组(P﹤0.01);保留LCA组患者的结肠造瘘率、吻合口瘘发生率均低于不保留LCA组(P﹤0.05)。结论腹腔镜直肠癌前切除术中保留LCA能保证结肠残端及吻合口的血供,降低末端结肠造瘘的发生率,缩短术后首次排气时间并降低术后吻合口瘘的发生风险。
Objective To compare the effects of two different management methods of left colic artery(LCA) in laparoscopic anterior resection of rectal cancer on the incidence of complications among patients with rectal cancer. Method150 patients treated with laparoscopic anterior resection for rectal cancer were assigned as preserved LCA group(n=85)and non-preserved LCA group(n=65), respectively. Surgical indicators and incidence of postoperative complications were compared between the two groups. Result There was no significant difference between the two groups in terms of volume of intraoperative blood loss, operative time, number of lymph node dissected and number of positive lymph nodes in 253 groups(P>0.05). The first flatus time in preserved LCA group was significantly shorter than that in non-preserved LCA group(P<0.01); the incidence of sigmoid colostomy and anastomotic leakage in preserved LCA group were all lower compared to non-preserved LCA group respectively(P<0.05). Conclusion In the laparoscopic anterior resection of rectal cancer, the preservation of LCA can ensure the blood supply for proximal intestine, reducing the incidence of anastomotic leakage and sigmoid colostomy, with less time to first flatus.
Objective To compare the effects of two different management methods of left colic artery(LCA) in laparoscopic anterior resection of rectal cancer on the incidence of complications among patients with rectal cancer. Method150 patients treated with laparoscopic anterior resection for rectal cancer were assigned as preserved LCA group(n=85)and non-preserved LCA group(n=65), respectively. Surgical indicators and incidence of postoperative complications were compared between the two groups. Result There was no significant difference between the two groups in terms of volume of intraoperative blood loss, operative time, number of lymph node dissected and number of positive lymph nodes in 253 groups(P>0.05). The first flatus time in preserved LCA group was significantly shorter than that in non-preserved LCA group(P<0.01); the incidence of sigmoid colostomy and anastomotic leakage in preserved LCA group were all lower compared to non-preserved LCA group respectively(P<0.05). Conclusion In the laparoscopic anterior resection of rectal cancer, the preservation of LCA can ensure the blood supply for proximal intestine, reducing the incidence of anastomotic leakage and sigmoid colostomy, with less time to first flatus.
引文
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[2]姚宏伟,刘萌华.基于循证医学证据的腹腔镜直肠癌手术疗效评价[J].中华外科杂志, 2017, 55(1):28-31.
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[4]张鲁阳,臧潞,马君俊,等.腹腔镜直肠癌根治术中保留左结肠动脉的临床意义[J].中华胃肠外科杂志, 2016, 19(8):886-891.
[5] Seike K, Koda K, Saito N, et al. Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery[J]. Int J Colorectal Dis, 2007, 22(6):689-697.
[6] Cirocchi R, Trastulli S, Farinella E, et al. High tie versus low tie of the inferior mesenteric artery in colorectal cancer:a RCT is needed[J]. Surg Oncol, 2012, 21(3):e111-e123.
[7] Sekimoto M, Mizushima T, Mizushima T, et al. Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery[J]. Surg Endosc, 2011, 25(3):861-866.
[8] Bonnet S, Berger A, Hentati N, et al. High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery:impact on the gain in colon length and implications on the feasibility of anastomoses[J]. Dis Colon Rectum, 2012, 55(5):515-521.
[9] B?rlehner E, Benhidjeb T, Anders S, et al. Laparoscopic resection for rectal cancer:outcomes in 194 patients and review of the literature[J]. Surg Endosc, 2005, 19(6):757-766.
[10] Leichtle SW, Mouawad NJ, Welch KB, et al. Risk factors for anastomotic leakage after colectomy[J]. Dis Colon Rectem, 2012, 55(5):569-575.
[11] Lange JF, Komen N, Akkerman G, et al. Riolan’s arch:confusing, misnomer, and obsolete. A literature survey of the connection(s)between the superior and inferior mesenteric arteries[J]. Am J Surg, 2007, 193(6):742-748.
[12]黄俊,周家铭,万英杰,等. IMA血管分型及Riolan动脉弓缺如对腹腔镜直肠癌根治术后吻合口瘘发生率的影响[J].中华胃肠外科杂志, 2016, 19(10):1113-1118.
[13] Seike K, Koda K, Saito N, et al. Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery[J]. Int J Colorectal Dis, 2007, 22(6):689-697.
[14]洛洋,秦俊,陈建军,等.腹腔镜直肠癌手术中保留左结肠动脉与否疗效对比研究[J].中国实用外科杂志, 2017,37(6):660-664.
[2]姚宏伟,刘萌华.基于循证医学证据的腹腔镜直肠癌手术疗效评价[J].中华外科杂志, 2017, 55(1):28-31.
[3]秦长江,宋新明. IMA的高位结扎[J].中华胃肠外科杂志,2016, 19(8):884-885.
[4]张鲁阳,臧潞,马君俊,等.腹腔镜直肠癌根治术中保留左结肠动脉的临床意义[J].中华胃肠外科杂志, 2016, 19(8):886-891.
[5] Seike K, Koda K, Saito N, et al. Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery[J]. Int J Colorectal Dis, 2007, 22(6):689-697.
[6] Cirocchi R, Trastulli S, Farinella E, et al. High tie versus low tie of the inferior mesenteric artery in colorectal cancer:a RCT is needed[J]. Surg Oncol, 2012, 21(3):e111-e123.
[7] Sekimoto M, Mizushima T, Mizushima T, et al. Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery[J]. Surg Endosc, 2011, 25(3):861-866.
[8] Bonnet S, Berger A, Hentati N, et al. High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery:impact on the gain in colon length and implications on the feasibility of anastomoses[J]. Dis Colon Rectum, 2012, 55(5):515-521.
[9] B?rlehner E, Benhidjeb T, Anders S, et al. Laparoscopic resection for rectal cancer:outcomes in 194 patients and review of the literature[J]. Surg Endosc, 2005, 19(6):757-766.
[10] Leichtle SW, Mouawad NJ, Welch KB, et al. Risk factors for anastomotic leakage after colectomy[J]. Dis Colon Rectem, 2012, 55(5):569-575.
[11] Lange JF, Komen N, Akkerman G, et al. Riolan’s arch:confusing, misnomer, and obsolete. A literature survey of the connection(s)between the superior and inferior mesenteric arteries[J]. Am J Surg, 2007, 193(6):742-748.
[12]黄俊,周家铭,万英杰,等. IMA血管分型及Riolan动脉弓缺如对腹腔镜直肠癌根治术后吻合口瘘发生率的影响[J].中华胃肠外科杂志, 2016, 19(10):1113-1118.
[13] Seike K, Koda K, Saito N, et al. Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery[J]. Int J Colorectal Dis, 2007, 22(6):689-697.
[14]洛洋,秦俊,陈建军,等.腹腔镜直肠癌手术中保留左结肠动脉与否疗效对比研究[J].中国实用外科杂志, 2017,37(6):660-664.