摘要
目的分析腹腔镜直肠癌前切除术中处理肠系膜下动脉(IMA)时保留左结肠动脉(LCA)的临床价值,并探讨保留LCA的可行性。方法回顾性分析50例行腹腔镜直肠癌前切除术患者的临床资料,28例不保留LCA患者纳入对照组,22例保留LCA患者纳入观察组,统计并对比两组患者的手术时间、术中出血量、术后排气时间、末端回肠造口情况、IMA根部淋巴清扫数目与淋巴结转移率以及患者预后。结果两组患者的手术时间、术中出血量、术后排气时间、末端回肠造口情况、IMA根部淋巴清扫数目与淋巴结转移率比较差异均无统计学意义(P>0.05),观察组术后首次排气时间早于对照组(P<0.05);对照组3例吻合后加做末端回肠造口,4例因近端肠管血运障碍需游离结肠脾曲,观察组无此类情况,差异有统计学意义(P<0.05);两组患者组织学分型、IMA根部淋巴结情况、TNM分期比较差异均无统计学意义(P>0.05);两组患者的随访局部复发和肝转移发生情况比较差异均无统计学意义(P>0.05)。结论腹腔镜直肠癌前切除术中处理肠系膜下动脉时保留左结肠动脉对保证近端肠管血运有积极作用,具有一定的临床价值。
Objective To analyze whether to reserve left colic artery（ LCA） in management of inferior mesenteric artery（ IMA） during laparoscopic resection of rectal cancer and to analyze the clinical value of retaining left colic artery（ LCA）,and to discuss the cllinical significance and feasibility of retaining LCA. Methods The clinical data of 50 patients before laparoscopic colorectal cancer resection including 28 patients without retaining LCA in control group,and other 22 patients preserved LCA were including in the observation group. The operating time,intraoperative blood loss,postoperative exhaust time,terminal ileum colostomy,the number of IMA root lymph node cleaning and the rate of metastasis in lymph nodes and prognosis of patients were compared and statistically analyzed between patients in these 2 groups. Results The difference in operating time,intraoperative blood loss,postoperative exhaust time,terminal ileum colostomy,and the number of IMA root lymph node cleaned between these 2 groups was not statistically significant（ P〉0. 05）. The first time of postoperative exhaust time in patients of observation group was earlier than that of patients in control group（ P〈0. 05）. The anastomosis of terminal ileum after colostomy was performed in 3 cases of control group,4 cases with obstacle in proximal bowel blood supply to free colon splenic flexure. Patients in observation group had no such condition,the difference between these 2 groups was statistically significant（ P〈0. 05）. The difference in type of classification of histology,the condition of cleaning of IMA root nodes and TNM staging between patients of these 2 groups was not statistically significant（ P〉0. 05）. The difference in patients of these 2 groups with local recurrence and hepatic metastasis during follow-up period had no statistical significance（ P〉0. 05）. Conclusion The laparoscopic resection of rectal cancer in treatment of inferior mesenteric arteries of proximal bowel in order to keep blood supply of leftcolic artery has positive effect,and it has certain clinical value.
出处
《临床和实验医学杂志》
2017年第10期1013-1016,共4页
Journal of Clinical and Experimental Medicine
基金
江苏省临床医学科技专项项目(编号:BL2012029)
关键词
直肠癌
腹腔镜直肠癌前切除术
肠系膜下动脉
左结肠动脉
近端肠管血运
Colorectal cancer
Before laparoscopic colorectal cancer resection of inferior mesenteric artery
Left colic artery
Laparoscope
Proximal gut blood supply
