腹腔镜下直肠癌根治术中保留左结肠动脉的围手术期临床研究

Perioperative clinical study on the preservation of the left colonic artery in laparoscopic radical resection of rectal cancer

    摘要
  • 摘要:
      目的：   探讨腹腔镜直肠癌根治术（total mesorectal excision，TME）中保留左结肠动脉术式的可行性，以及对围手术期相关指标和并发症的影响。
      方法：  回顾性分析2017年1月至2019年6月于天津市第四中心医院收治的103例行TME患者的病例资料，其中保留左结肠血管52例（低位结扎组，观察组），不保留左结肠血管51例（高位结扎组，对照组），比较两组手术时间、术中出血量、胃肠道功能恢复时间、术后并发症、淋巴结清扫数量等。
      结果：  两组患者均无中转开腹病例，围手术期无死亡病例。对比观察组与对照组手术时间、出血量、淋巴结清扫数量分别为（188.2±9.0）min vs.（185.6±13.3）min，（53.9±4.1）mL vs.（54.4±4.1）mL，（18.5±1.8）枚vs.（19.4±2.1）枚，均差异无统计学意义（P>0.05）。术后观察组肠鸣音恢复时间早于对照组（21.2±2.0）h vs.（25.2±3.2）h，P < 0.05，差异有统计学意义；两组术后吻合口瘘以及吻合口狭窄发生率无显著差异（P>0.05）。两组术后2周膀胱残余尿比较，观察组少于对照组（34.8±8.4）mL vs.（45.5±15.6）mL，P < 0.05，差异有统计学意义。
      结论：  保留左结肠动脉的低位结扎术，不会减少吻合口瘘以及吻合口狭窄发生率，不影响吻合口的血供，不会延长手术时间，不会增加术中出血量，而且清扫的淋巴结数量（包括253组淋巴结数量）不少于高位结扎组，可以减少由于盆腔自主神经功能损伤导致的膀胱残余尿量增加的情况，并且可以加快术后胃肠功能的恢复。

     

    Abstract:
      Objective:  To investigate the feasibility of preserving the left colonic artery in laparoscopic radical resection of rectal cancer and its effect on perioperative indices and complications.
      Methods:  The clinical data of 103 patients who underwent laparoscopic radical resection of rectal cancer in Tianjin Fourth Central Hospital from January 2017 to June 2019 were analyzed retrospectively. There were 52 cases involving the preservation of the left colonic vessels; in 51 cases, the left colonic vessels were not preserved. Operation time, intraoperative blood loss, time to the recovery of gastrointestinal function, postoperative complications, and the number of dissected lymph nodes were compared between the two groups.
      Results:  There were no cases involving conversion to open laparotomy; no perioperative deaths were noted in either group. Operation time, blood loss, and the number of dissected lymph nodes in the observation group vs. control group were (188.2±9.0) min vs. (185.6±13.3) min, (53.9±4.1) mL vs. (54.4±4.1) mL, and (18.5±1.8) vs. (19.4±2.1), respectively; there were no significant differences between the two groups (P>0.05). The recovery time of bowl sounds was shorter in the observation group than in the control group(21.2±2.0) h vs. (25.2±3.2) h, P < 0.05. There were no significant differences in the incidence of anastomotic leakage or anastomotic stricture between the two groups (P>0.05). Two weeks after the operation, the volume of residual urine in the bladder was significantly lower in the observation group than in the control group(34.8±8.4)mL vs. (45.5±15.6)mL, P < 0.05.
      Conclusions:  Low ligation of the left colonic artery did not reduce the incidence of anastomotic leakage or anastomotic stenosis and did not affect the blood supply of the anastomosis. Furthermore, it did not prolong the operation time or increase the amount of intraoperative bleeding. The number of dissected lymph nodes (including 253 lymph nodes) in the low ligation group was not less than that in the high ligation group. Low ligation can reduce the increase in the volume of residual urine in the bladder caused by a loss of pelvic autonomic nerve function and can accelerate the postoperative recovery of gastrointestinal function.

     

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