腹腔镜直肠癌前切除术中保留左结肠动脉对术后吻合口漏及近期疗效的影响
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摘要
目的探讨腹腔镜直肠癌前切除术中保留左结肠动脉(LCA)对病人术后吻合口漏及近期疗效的影响。方法腹腔镜直肠癌前切除术病人100例,根据手术方式分为两组,观察组44例,保留LCA低位结扎肠系膜下动脉(IMA),对照组56例,不保留LCA。比较两组病人术后病理检查结果、围手术期指标、术后并发症发生情况,术前及术后6、12个月测定血清抗血管生成趋化因子CXCL9、可溶性E-选择素(sE-selectin)、癌胚抗原(CEA)、糖类抗原199(CA199),统计1年和3年复发转移率和生存率。结果两组一般资料及术后病理资料(第3站淋巴结转移率、病理类型、TNM分期)比较,差异无统计学意义(P>0.05)。观察组与对照组的淋巴结清扫数分别为(12.44±1.92)枚和(12.61±2.23)枚,手术时间分别为(130.59±17.48)小时和(128.06±16.11)小时,术中出血量分别为(74.85±14.69)ml和(77.43±16.86)ml,两组比较差异均无统计学意义(P>0.05);观察组与对照组的术后排气时间分别为(72.53±1.79)小时和(76.11±2.82)小时,住院时间分别为(5.66±0.45)天和(6.22±0.53)天,差异有统计学意义(P<0.05)。观察组切口感染、肠梗阻、尿潴留、性功能障碍、控便不佳发生率分别为0.00、2.27%、4.55%、2.27%、2.27%,对照组分别为3.57%、3.57%、7.14%、3.57%、8.93%,差异无统计学意义(P>0.05);观察组无吻合口漏发生,对照组为10.71%,差异有统计学意义(P<0.05)。术后6、12个月,两组血清CXCL9、sE-selectin、CEA、CA199水平均低于术前(P<0.05),但组间比较差异无统计学意义(P>0.05)。术后1、3年,观察组复发转移率分别为4.55%、20.45%,对照组分别为3.57%和19.64%,两组比较差异无统计学意义(P>0.05);观察组总生存率分别为97.73%、84.09%,对照组分别为100.00%和85.71%,差异无统计学意义(P>0.05)。结论腹腔镜直肠癌前切除术中保留LCA有利于保护吻合口近端血运,降低术后吻合口漏发生率,且不增加手术难度及术后复发转移风险。
Objective To explore the influence of preserving left colic artery(LCA)during during laparoscopic anterior resection for rectal cancer on anastomotic leakage and recent efficacy.Methods The clinical data of 138 patients undergoing laparoscopic anterior resection for rectal cancer r were retrospectively analyzed.The patients were divided into two groups according to the operation method:62 patients with preservation of LCA with low ligation of the inferior mesenteric artery(IMA)as the observation group,76 patients without preservation of LCA and high ligation of the IMA as control group.The general data,postoperative pathological findings,perioperative indicators,and postoperative complications were compared between the two groups.Serum anti-angiogenic chemokine CXCL9,soluble E selectin(sE-selectin),carcinoembryonic antigen(CEA)and carbohydrate antigen 199(CA199)were measured before and 6,12 months after surgery.All were followed up for 3 years to report recurrence and metastasis.Results There was no significant differences in general data and postoperative pathological findings(3 rd station lymph node metastasis rate,pathological type,TNM staging)between the two groups(P>0.05).There was no significant difference in the number of lymph node dissections [(12.44±1.92)vs(12.61±2.23)],operation time [(130.59±17.48)h vs(128.06±16.11)h],intraoperative blood loss [(74.85±14.69)ml vs(77.43±16.86)ml] between the observation group and the control group(P>0.05),while the difference of postoperative exhaust time [(72.53±1.79)h vs(76.11±2.82)h] and the postoperative hospital stay[(5.66±0.45)d vs(6.22±0.53)d] between the two groups was significant(P<0.05).There was no significant differences in incision infection(0 vs 3.57%),intestinal obstruction(2.27% vs 3.57%),urinary retention(4.55% vs 7.14%),sexual dysfunction(2.27% vs 3.57%),poor stool control(2.27% vs 8.93%)between the observation group and the control group(P>0.05),while the difference of anastomotic leakage(0 vs 10.71%)between the two groups was significant(P<0.05).At 6 and 12 months after operation,the serum levels of CXCL9,sE-selectin,CEA and CA199 were significantly lower than before operation(P<0.05),but there were no significant differences between the two groups(P>0.05).At 1 and 3 years after surgery,the recurrence and metastasis rates in the observation group were 4.55% and 20.45% respectively,which were not statistically different with 3.57% and 19.64% in the control group(P>0.05).The overall survival rate in the observation group was 97.73% and 84.09%,which were not statistically different with 100.00% and 85.71% in the control group(P>0.05).Conclusion Preserving LCA during laparoscopic anterior resection of rectal cancer is beneficial to protect blood flow in the proximal anastomosis and reduce the incidence of postoperative anastomotic leakage,without increasing the difficulty of surgery and the risk of postoperative recurrence and metastasis.
Objective To explore the influence of preserving left colic artery(LCA)during during laparoscopic anterior resection for rectal cancer on anastomotic leakage and recent efficacy.Methods The clinical data of 138 patients undergoing laparoscopic anterior resection for rectal cancer r were retrospectively analyzed.The patients were divided into two groups according to the operation method:62 patients with preservation of LCA with low ligation of the inferior mesenteric artery(IMA)as the observation group,76 patients without preservation of LCA and high ligation of the IMA as control group.The general data,postoperative pathological findings,perioperative indicators,and postoperative complications were compared between the two groups.Serum anti-angiogenic chemokine CXCL9,soluble E selectin(sE-selectin),carcinoembryonic antigen(CEA)and carbohydrate antigen 199(CA199)were measured before and 6,12 months after surgery.All were followed up for 3 years to report recurrence and metastasis.Results There was no significant differences in general data and postoperative pathological findings(3 rd station lymph node metastasis rate,pathological type,TNM staging)between the two groups(P>0.05).There was no significant difference in the number of lymph node dissections [(12.44±1.92)vs(12.61±2.23)],operation time [(130.59±17.48)h vs(128.06±16.11)h],intraoperative blood loss [(74.85±14.69)ml vs(77.43±16.86)ml] between the observation group and the control group(P>0.05),while the difference of postoperative exhaust time [(72.53±1.79)h vs(76.11±2.82)h] and the postoperative hospital stay[(5.66±0.45)d vs(6.22±0.53)d] between the two groups was significant(P<0.05).There was no significant differences in incision infection(0 vs 3.57%),intestinal obstruction(2.27% vs 3.57%),urinary retention(4.55% vs 7.14%),sexual dysfunction(2.27% vs 3.57%),poor stool control(2.27% vs 8.93%)between the observation group and the control group(P>0.05),while the difference of anastomotic leakage(0 vs 10.71%)between the two groups was significant(P<0.05).At 6 and 12 months after operation,the serum levels of CXCL9,sE-selectin,CEA and CA199 were significantly lower than before operation(P<0.05),but there were no significant differences between the two groups(P>0.05).At 1 and 3 years after surgery,the recurrence and metastasis rates in the observation group were 4.55% and 20.45% respectively,which were not statistically different with 3.57% and 19.64% in the control group(P>0.05).The overall survival rate in the observation group was 97.73% and 84.09%,which were not statistically different with 100.00% and 85.71% in the control group(P>0.05).Conclusion Preserving LCA during laparoscopic anterior resection of rectal cancer is beneficial to protect blood flow in the proximal anastomosis and reduce the incidence of postoperative anastomotic leakage,without increasing the difficulty of surgery and the risk of postoperative recurrence and metastasis.
引文
[1]Parnaby CN,Scott NW,Ramsay G,et al.P rognostic value of lymphnode ratio and extramural vascular in vasion on survival for patients undergoing curative colon cancer resection[J].Br J Cancer,2015,113(2):212-219.
[2]成军,周玲,陈涛,等.保留左结肠动脉的腹腔镜低位直肠癌前切除术[J].中国微创外科杂志,2017,17(9):780-782.
[3]包勇磊,费伯健.保留左结肠动脉对直肠癌微创手术效果的影响[J].实用癌症杂志,2018,33(1):99-101.
[4]刘飞,张李安.腹腔镜直肠癌前切除术中保留左结肠动脉与否的临床对照研究[J].临床和实验医学杂志,2017,16(10):1013-1016.
[5]汤瑜,卢晓明,童强,等.腹腔镜与开腹手术在结直肠癌术后吻合口瘘发病率及临床疗效的对比研究[J].临床外科杂志,2018,26(1):39-42.
[6]徐谊,赵晓牧,孙武青,等.直肠癌低位前切除术后吻合口瘘发生相关因素分析[J].首都医科大学学报,2017,38(5):727-732.
[7]Khan AA,Akritidis G,Pring T,et al.The Neutrophil-to-Lymphocyte Ratio as a Marker of Lymph Node Status in Patients with Reetal Cancer[J].Oneology,2016,91(2):69-77.
[8]魏君,邱磊,谢沛标,等.保留左结肠动脉与否对腹腔镜直肠癌切除术疗效的影响研究[J].结直肠肛门外科,2018,57(2):130-133.
[9]刘彦魁,游庆军,金琳芳,等.CXCL13及其受体CXCR5与结直肠癌转移及KRAS基因突变关系的探讨[J].山东医药,2014,54(34):1-4.
[10]洪亮,殷庆章,程志俭,等.结直肠癌术后患者血清趋化因子CX-CL9变化及其与肿瘤复发、转移的关系[J].胃肠病学,2015,20(1):10-13.
[11]庆琳琳,胡继春.结直肠腺癌组织中c-JUN氨基末端激酶、E-选择素、血管内皮生长因子-D蛋白表达的临床意义[J].中国医药导报,2015,12(5):95-98.
[12]张鑫东,葛晓蕾,刘省存,等.血清CA199和CEA对结直肠癌转移和预后预测的价值[J].中华疾病控制杂志,2018,22(1):57-61.
[13]骆洋,陈建军,秦骏,等.腹腔镜直肠癌根治术中肠系膜下动脉低位结扎对第3站淋巴结清扫的影响及第3站淋巴结转移危险因素分析[J].中华消化外科杂志,2018,17(2):154-160.
[2]成军,周玲,陈涛,等.保留左结肠动脉的腹腔镜低位直肠癌前切除术[J].中国微创外科杂志,2017,17(9):780-782.
[3]包勇磊,费伯健.保留左结肠动脉对直肠癌微创手术效果的影响[J].实用癌症杂志,2018,33(1):99-101.
[4]刘飞,张李安.腹腔镜直肠癌前切除术中保留左结肠动脉与否的临床对照研究[J].临床和实验医学杂志,2017,16(10):1013-1016.
[5]汤瑜,卢晓明,童强,等.腹腔镜与开腹手术在结直肠癌术后吻合口瘘发病率及临床疗效的对比研究[J].临床外科杂志,2018,26(1):39-42.
[6]徐谊,赵晓牧,孙武青,等.直肠癌低位前切除术后吻合口瘘发生相关因素分析[J].首都医科大学学报,2017,38(5):727-732.
[7]Khan AA,Akritidis G,Pring T,et al.The Neutrophil-to-Lymphocyte Ratio as a Marker of Lymph Node Status in Patients with Reetal Cancer[J].Oneology,2016,91(2):69-77.
[8]魏君,邱磊,谢沛标,等.保留左结肠动脉与否对腹腔镜直肠癌切除术疗效的影响研究[J].结直肠肛门外科,2018,57(2):130-133.
[9]刘彦魁,游庆军,金琳芳,等.CXCL13及其受体CXCR5与结直肠癌转移及KRAS基因突变关系的探讨[J].山东医药,2014,54(34):1-4.
[10]洪亮,殷庆章,程志俭,等.结直肠癌术后患者血清趋化因子CX-CL9变化及其与肿瘤复发、转移的关系[J].胃肠病学,2015,20(1):10-13.
[11]庆琳琳,胡继春.结直肠腺癌组织中c-JUN氨基末端激酶、E-选择素、血管内皮生长因子-D蛋白表达的临床意义[J].中国医药导报,2015,12(5):95-98.
[12]张鑫东,葛晓蕾,刘省存,等.血清CA199和CEA对结直肠癌转移和预后预测的价值[J].中华疾病控制杂志,2018,22(1):57-61.
[13]骆洋,陈建军,秦骏,等.腹腔镜直肠癌根治术中肠系膜下动脉低位结扎对第3站淋巴结清扫的影响及第3站淋巴结转移危险因素分析[J].中华消化外科杂志,2018,17(2):154-160.