精准保留左结肠动脉并根部淋巴结清扫的腹腔镜直肠癌根治术的疗效分析

目的:探讨腹腔镜下直肠癌根治术中根据肠系膜下动脉(IMA)不同分型精准保留左结肠动脉(LCA)及根部淋巴结清扫的临床意义。方法:采用回顾性对比性的方法纳入2016年6月至2018年6月施行的72例腹腔镜下直肠癌根治术,其中38例根据IMA分型行精准保留LCA并廓清IMA根部淋巴结(保留LCA组),34例不保留LCA,行传统高位结扎术(高位结扎组);对比分析两组临床资料、围手术期疗效指标及术后恢复情况。结果:两组手术均顺利完成,无一例中转开腹,两组手术时间、术中出血量、预防性造口率及术后病理分期差异无统计学意义(P>0.05),两组淋巴结清扫总数、阳性淋巴结数量差异无统计学意义(P>0.05)。保留LCA组术后1例发生吻合口出血,高位结扎组术后2例发生排尿功能障碍、2例吻合口漏,两组术后并发症总发生率分别为2.6%与11.8%,差异有统计学意义(P<0.05)。结论:腹腔镜直肠癌根治术中保留LCA并清扫根部淋巴结可达到肿瘤根治效果,并能降低术后总并发症发生率,是安全、有效的。

Laparoscopic radical resection of rectal cancer with precise preservation of left colonic artery and radical lymphadenectomy

Objective:To explore the clinical significance of precise preserving left colon(LCA)and root lymph node dissection according to different subtypes of inferior mesenteric artery(IMA)in laparoscopic radical resection of rectal cancer.Methods:From Jun.2016 to Jun.2018,a retrospective analysis was conducted.72 cases of laparoscopic radical resection of rectal cancer were enrolled.Among them,38 patients underwent precise preservation of LCA and clearance of IMA root lymph nodes according to different types of IMA(LCA group);34 cases underwent traditional high ligation without LCA(high ligation group);The clinical data of the two groups were analyzed retrospectively,and the perioperative efficacy indexes and postoperative recovery were compared.Results:The operations of two groups were successfully completed without conversion to open surgery.There was no significant difference in operation time,intraoperative bleeding volume,prophylactic stoma rate and postoperative pathological stage between the two groups(P>0.05).There was no significant difference between the two groups in the total number of lymph node dissection and the positive rate of lymph nodes(P>0.05).There was 1 anastomotic bleeding in LCA group,2 urinary dysfunction and 2 anastomotic leakage in high ligation group.The total incidence of complications in two groups was 2.6%and 11.8%,respectively,with statistical significance(P<0.05).Conclusions:In laparoscopic radical resection of rectal cancer,LCA preservation and root lymph node dissection can achieve the effect of radical resection,and reduce the incidence of total postoperative complications,it is safe and effective.