腹腔镜直肠癌根治术中保留左结肠动脉的临床观察
摘要
目的探讨腹腔镜直肠癌根治术中保留左结肠动脉的疗效及价值。方法选取2012年6月至2013年3月河南省郑州市第七人民医院收治的直肠癌患者60例,依据随机数字表法分为观察组和对照组各30例,两组均行腹腔镜直肠癌根治术,对照组术中不保留左结肠动脉,观察组术中保留左结肠动脉。比较两组患者术中及术后情况,随访观察肿瘤复发、转移及5年生存率情况。结果两组患者均顺利完成手术,无中转开腹及术中严重并发症的发生。两组手术时间、术中出血量、残端缺血性改变、淋巴结清扫数、肠系膜下动脉(IMA)根部淋巴结清扫数、IMA根部清扫淋巴结阳性率及肿瘤下切缘距离差异均无显著性(P>0.05)。两组术后吻合口出血、吻合口瘘、排气时间、住院天数差异均无显著性(P>0.05)。两组患者肝转移发生率及5年生存率差异无显著性(P>0.05)。结论腹腔镜直肠癌根治术中保留左结肠动脉可有效保障近端肠管血运,且不延长手术时间及增加术后并发症,同时可完成与不保留左结肠动脉相似的淋巴清扫。
引文
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[11] Singh D, Luo J, Liu XT, et al. The long-term survival benefits of high and low ligation of inferior mesenteric artery in colorectal cancer surgery[J]. Medicine, 2017, 96(47):8520-8527.
[12]熊育建,程科蔚,郑刚.肠系膜下动脉高位结扎对直肠癌术后并发症发生及患者生活质量的影响[J].实用癌症杂志,2015,30(9):1350-1353.
[13]黄进林,严伟华,伍志辉.低位结扎IMA与高位结扎IMA治疗直肠癌的手术疗效及术后生命质量比较[J].广州医学院学报,2017, 45(3):69-72.
[14] Circchi 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):111-123.
[15] Sekimoto M, Takemasa I, Mizushima T, et al. Laparoscopic lymph node dissection around the inferior mesenteric artery wifh preservation of the left colic artery[J]. Surg Endosc, 2011, 25(3):861-866.
[16] Goh N, Fong SS, How KY, et al. Apical lymph node dissection of the inferior mesenteric artery(ALMA)[J]. Colorect Dis, 2016, 18(6):206-209.
[17] 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.
[2]李畅,段立美,季艳艳.加速康复外科模式对腹腔镜结直肠癌手术患者免疫功能及术后疼痛的影响[J].癌症进展,2018,16(11):1438-1442.
[3]李艳梅,赵卫威,李鹏,等.用~(18)F-FDG PET/CT原发灶代谢体积预测直肠癌转移临床研究[J].中国临床医生杂志,2018,46(7):815-818.
[4] Charan I, Kapoor A, Singhal MK, et al. High ligation of inferior mesenteric artery in left colonic and rectal cancers:lymph node yield and survival benefit[J]. Indian J Surg, 2015, 77(3):1103-1109.
[5]Cirocchi R, Farinella E, Trastulli S, et al. High tie versus low tie of the inferior mesenteric artery:a protocol for a systematic review[J].World J Surg Oncol, 2011,9(1):147.
[6]臧潞,马君俊,郑民华.直肠癌根治术中保留左结肠动脉对吻合口瘘及手术时间的影响[J].中华胃肠外科杂志,2016, 19(4):386-387.
[7]康博雄,夏博伟,樊勇,等.腹腔镜下头侧中间人路在保留左结肠动脉的Dixon手术中的应用(附22例报告)[J].中国微创外科杂志,2017, 17(10):897-898.
[8] Edge SB, Compton CC. The American joint committee on cancer:the 7th edition of the AJCC cancer staging manual, and the future of TNM[J]. Ann Surg Oncol, 2010, 17(6):1471-1474.
[9]陶振洲,曹广,梁杰雄,等.3D与2D腹腔镜结直肠癌根治术临床疗效比较[J].中国医药,2018,13(6):895-898.
[10] Chin CC, Yeh CY, Tang R, et al. The oncologic benefit of high ligation of the inferior mesenteric artery in the surgical treatment of rectal or sigmoid colon cancer[J]. Int J Colorect Dis, 2008, 23(8):783-788.
[11] Singh D, Luo J, Liu XT, et al. The long-term survival benefits of high and low ligation of inferior mesenteric artery in colorectal cancer surgery[J]. Medicine, 2017, 96(47):8520-8527.
[12]熊育建,程科蔚,郑刚.肠系膜下动脉高位结扎对直肠癌术后并发症发生及患者生活质量的影响[J].实用癌症杂志,2015,30(9):1350-1353.
[13]黄进林,严伟华,伍志辉.低位结扎IMA与高位结扎IMA治疗直肠癌的手术疗效及术后生命质量比较[J].广州医学院学报,2017, 45(3):69-72.
[14] Circchi 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):111-123.
[15] Sekimoto M, Takemasa I, Mizushima T, et al. Laparoscopic lymph node dissection around the inferior mesenteric artery wifh preservation of the left colic artery[J]. Surg Endosc, 2011, 25(3):861-866.
[16] Goh N, Fong SS, How KY, et al. Apical lymph node dissection of the inferior mesenteric artery(ALMA)[J]. Colorect Dis, 2016, 18(6):206-209.
[17] 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.