保留左结肠动脉在腹腔镜直肠癌低位前切除术中的应用
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摘要
目的探讨在腹腔镜直肠癌低位前切除术中保留左结肠动脉(left colonic artery,LCA)的临床疗效及可行性。方法回顾性分析2014年9月—2018年2月于蚌埠医学院第二附属医院普外科行腹腔镜直肠癌低位前切除术的52例患者的临床资料。将52例患者根据手术方式分成2组,保留LCA组患者26例,肠系膜下动脉(inferior mesenteric artery,IMA)高位结扎组26例。比较和分析2组患者在回肠造口例数、游离脾区例数、手术时间、术中出血量、淋巴结清扫总数目、第3站淋巴结清扫数目、术后肛门排气时间、吻合口瘘发生率、肠梗阻发生率、排粪失禁发生率以及术后随访12个月肿瘤复发及转移情况等方面的差异。结果保留LCA组与IMA高位结扎组在回肠造口例数、游离脾区例数、手术时间、术中出血量、淋巴结清扫总数目、第3站淋巴结清扫数目、术后肠梗阻发生率、排粪失禁发生率以及术后随访12个月肿瘤复发及转移情况等方面差异均无统计学意义(均P>0.05)。IMA高位结扎组术后肛门排气时间为(2.80±0.52)d,术后发生吻合口瘘6例,而保留LCA组术后肛门排气时间为(2.44±0.44)d,无吻合口瘘发生,组间差异均具有统计学意义(均P<0.05)。结论保留LCA直肠癌低位前切除术临床疗效与肠系膜下动脉高位结扎相当,保留LCA可有效缩短患者术后肛门排气时间,降低吻合口瘘发生率。
Objective To investigate the clinical efficacy and feasibility of preservation of the left colonic artery(LCA) in laparoscopic anterior resection of low rectal cancer. Methods The clinical data of 52 patients treated with laparoscopic anterior resection in our hospital from September 2014 to February 2018 were analyzed retrospectively and 52 patients were divided into two groups according to the operation method, including 26 cases with preservation of the LCA and 26 cases with high ligation group in inferior mesenteric artery(IMA). The differences of two groups on ileostomy number, free spleen number, operation time, intraoperative blood loss, lymph node dissection number, lymph node dissection number in the third station, postoperative anal exhaust time, anastomotic leakage incidence, intestinal obstruction incidence, fecal incontinence incidence, and tumor recurrence after 12 months were analyzed and compared. Results There were no differences between LCA group and IMA group on ileostomy number, free spleen number, operation time, intraoperative blood loss, lymph node dissection number, lymph node dissection number in the third station, anastomotic leakage incidence, intestinal obstruction incidence, fecal incontinence incidence, and tumor recurrence after 12 months(all P>0.05). In IMA group, the postoperative anal exhaust time was(2.80±0.52)d, and postoperative anastomotic leakage number was 6 cases; in LCA group, the postoperative anal exhaust time was(2.44±0.44)d, and postoperative anastomotic leakage number was 0 case; the differences between the two groups were statistically significant(all P<0.05). Conclusion The clinical efficacy of preservation of the left colonic artery(LCA) in laparoscopic anterior resection is equivalent with high ligation group in inferior mesenteric artery. And preservation of LCA could effectively reduce the anal exhaust time and anastomotic fistula rate.
Objective To investigate the clinical efficacy and feasibility of preservation of the left colonic artery(LCA) in laparoscopic anterior resection of low rectal cancer. Methods The clinical data of 52 patients treated with laparoscopic anterior resection in our hospital from September 2014 to February 2018 were analyzed retrospectively and 52 patients were divided into two groups according to the operation method, including 26 cases with preservation of the LCA and 26 cases with high ligation group in inferior mesenteric artery(IMA). The differences of two groups on ileostomy number, free spleen number, operation time, intraoperative blood loss, lymph node dissection number, lymph node dissection number in the third station, postoperative anal exhaust time, anastomotic leakage incidence, intestinal obstruction incidence, fecal incontinence incidence, and tumor recurrence after 12 months were analyzed and compared. Results There were no differences between LCA group and IMA group on ileostomy number, free spleen number, operation time, intraoperative blood loss, lymph node dissection number, lymph node dissection number in the third station, anastomotic leakage incidence, intestinal obstruction incidence, fecal incontinence incidence, and tumor recurrence after 12 months(all P>0.05). In IMA group, the postoperative anal exhaust time was(2.80±0.52)d, and postoperative anastomotic leakage number was 6 cases; in LCA group, the postoperative anal exhaust time was(2.44±0.44)d, and postoperative anastomotic leakage number was 0 case; the differences between the two groups were statistically significant(all P<0.05). Conclusion The clinical efficacy of preservation of the left colonic artery(LCA) in laparoscopic anterior resection is equivalent with high ligation group in inferior mesenteric artery. And preservation of LCA could effectively reduce the anal exhaust time and anastomotic fistula rate.
引文
[1] HAIN E,MAGGIORI L,MANCEAU G,et al.Oncological impact of anastomotic leakage after laparoscopic mesorectal excision[J].Brit J Surg,2016,104(3):288-295.
[2] 黄胜辉,池畔,林惠铭,等.直肠癌保肛术后迟发型吻合口瘘的影响因素及临床特点[J].中华胃肠外科杂志,2016,19(4):390-395.
[3] 曾祥岳,孙振强,王海江.734例直肠癌术后吻合口瘘的影响因素分析[J].中华肿瘤防治杂志,2016,23(5):322-325.
[4] QIN Q,MA T,DENG Y,et al.Impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection[J].Dise Colon Rectum,2016,59(10):934-942.
[5] 刘焕然,胡祥,张健,等.肠系膜下动脉CT动脉造影分型与淋巴结转移相关性研究[J].中国实用外科杂志,2015,35(7):756-759.
[6] MARINELLO F G,BAGUENA G,LUCAS E,et al.Anastomotic leakage after colon cancer resection:does the individual surgeon matter?[J].Colorectal Dis,2016,18(6):562-569.
[7] 陈纲,李世拥.腹腔镜直肠癌根治保留左结肠血管的技巧及意义[J].中华普外科手术学杂志(电子版),2018,12(1):9-11.
[8] 黄俊,周家铭,万英杰,等.肠系膜下动脉血管分型及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.
[9] 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.
[10] 向德雨,秦章禄,胡侃,等.保留左结肠动脉并留置肛管在直肠癌前切除术中的应用[J].中国基层医药,2018,25(4):470-473.
[11] BONNET S,BERGER A,HENTATI N,et al.High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery[J].Dis Colon Rectum,2012,55(5):515-521.
[12] 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.
[13] 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.
[14] 向国卿,赵莹,朱佳,等.9 769例结直肠癌的构成特征及变化趋势[J].现代肿瘤医学,2016,20(24):3236-3239.
[15] 徐向辉,盛金鑫,钟林,等.保留左结肠动脉的腹腔镜直肠癌手术对患者预后的影响[J].现代消化及介入诊疗,2018,23(5):548-550.
[16] 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,2018,24(2):36-39.
[17] 李心翔,李清国.腹腔镜直肠癌术中左结肠动脉保留的意义[J].中华胃肠外科杂志,2018,21(3):272-275.
[18] 骆洋,秦骏,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):72-76.
[2] 黄胜辉,池畔,林惠铭,等.直肠癌保肛术后迟发型吻合口瘘的影响因素及临床特点[J].中华胃肠外科杂志,2016,19(4):390-395.
[3] 曾祥岳,孙振强,王海江.734例直肠癌术后吻合口瘘的影响因素分析[J].中华肿瘤防治杂志,2016,23(5):322-325.
[4] QIN Q,MA T,DENG Y,et al.Impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection[J].Dise Colon Rectum,2016,59(10):934-942.
[5] 刘焕然,胡祥,张健,等.肠系膜下动脉CT动脉造影分型与淋巴结转移相关性研究[J].中国实用外科杂志,2015,35(7):756-759.
[6] MARINELLO F G,BAGUENA G,LUCAS E,et al.Anastomotic leakage after colon cancer resection:does the individual surgeon matter?[J].Colorectal Dis,2016,18(6):562-569.
[7] 陈纲,李世拥.腹腔镜直肠癌根治保留左结肠血管的技巧及意义[J].中华普外科手术学杂志(电子版),2018,12(1):9-11.
[8] 黄俊,周家铭,万英杰,等.肠系膜下动脉血管分型及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.
[9] 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.
[10] 向德雨,秦章禄,胡侃,等.保留左结肠动脉并留置肛管在直肠癌前切除术中的应用[J].中国基层医药,2018,25(4):470-473.
[11] BONNET S,BERGER A,HENTATI N,et al.High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery[J].Dis Colon Rectum,2012,55(5):515-521.
[12] 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.
[13] 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.
[14] 向国卿,赵莹,朱佳,等.9 769例结直肠癌的构成特征及变化趋势[J].现代肿瘤医学,2016,20(24):3236-3239.
[15] 徐向辉,盛金鑫,钟林,等.保留左结肠动脉的腹腔镜直肠癌手术对患者预后的影响[J].现代消化及介入诊疗,2018,23(5):548-550.
[16] 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,2018,24(2):36-39.
[17] 李心翔,李清国.腹腔镜直肠癌术中左结肠动脉保留的意义[J].中华胃肠外科杂志,2018,21(3):272-275.
[18] 骆洋,秦骏,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):72-76.