摘要
目的探讨保留左结肠动脉(LCA)的腹腔镜全直肠系膜切除术(TME)治疗中低位直肠癌的临床效果。方法选择2018年1月至2020年1月收诊的80例中低位直肠癌患者作为研究对象,根据腹腔镜TME中是否保留LCA将其分为观察组(腹腔镜TME中予以保留LCA)和对照组(腹腔镜TME中未予以保留LCA),各40例。比较两组的手术相关指标[手术时间、术中出血量、吻合口距肛缘距离、边缘动脉弓压力、肠系膜下动脉(IMA)根部淋巴结清扫数目、术后通气时间]、炎性因子水平、胃肠功能指标、血流灌注时间、术后并发症发生情况。结果两组的手术时间、术中出血量、吻合口距肛缘距离、IMA根部淋巴结清扫数目比较,差异无统计学意义(P>0.05);观察组的边缘动脉弓压力小于对照组,术后通气时间短于对照组,差异具有统计学意义(P<0.05)。观察组的术中造口、游离脾曲发生率及术后并发症总发生率低于对照组,差异具有统计学意义(P<0.05)。术后3 d,两组的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平均降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。术后7 d,两组的胃泌素(GAS)、胃动素(MTL)水平均降低,但观察组高于对照组,差异具有统计学意义(P<0.05)。术前及术后1 d,两组的血流灌注时间比较,差异无统计学意义(P>0.05);术后1 d,对照组的血流灌注时间长于术前,差异具有统计学意义(P<0.05)。结论保留LCA的腹腔镜TME治疗中低位直肠癌患者的效果较好,可减轻患者的炎症反应,有效控制并发症,临床可行性及安全性高。
Objective To investigate the clinical effect of laparoscopic total mesorectal excision(TME)with preservation of left colic artery(LCA)in the treatment of middle and low rectal cancer.Methods From January 2018 to January 2020,80 patients with middle and low rectal cancer were selected as the research objects.According to whether LCA was retained in laparoscopic TME,the patients were divided into observation group(LCA was retained in laparoscopic TME)and control group(LCA was not retained in laparoscopic TME),with 40 cases in each group.The operation-related indexes[operation time,intraoperative blood loss,distance from anastomosis to anal margin,marginal aortic arch pressure,number of lymph node dissection at inferior mesenteric artery(IMA)root and postoperative ventilation time],inflammatory factors levels,gastrointestinal function indexes,blood perfusion time and occurrence of postoperative complications were compared between the two groups.Results There were no significant differences in operation time,intraoperative blood loss,distance from anastomosis to anal margin and number of lymph node dissection at IMA root between the two groups(P>0.05);the marginal aortic arch pressure of the observation group was lower than that of the control group,the postoperative ventilation time was shorter than that of the control group,and the differences were statistically significant(P<0.05).The incidences of stoma,free splenic flexure and the total incidence of postoperative complications in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).At 3 d after operation,the levels of interleukin-6(IL-6)and interleukin-8(IL-8)in the two groups decreased,and those in the observation group were lower than the control group,and the differences were statistically significant(P<0.05).At 7 d after operation,the levels of gastrin(GAS)and motilin(MTL)in the two groups decreased,but those in the observation group were higher than the control group,and the differences were statistically significant(P<0.05).Before and 1 d after operation,there was no significant difference in blood perfusion time between the two groups(P>0.05);at 1 d after operation,the blood perfusion time of the control group was longer than that before operation,and the difference was statistically significant(P<0.05).Conclusion Laparoscopic TME with LCA preservation is effective in the treatment of patients with middle and low rectal cancer,which can reduce the inflammatory response of patients,effectively control complications,and has high clinical feasibility and safety.
作者
杨得振
刘园蔚
董明
贾勇
袁虎豹
YANG Dezhen;LIU Yuanwei;DONG Ming;JIA Yong;YUAN Hubao(Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China)
出处
《临床医学研究与实践》
2023年第5期43-46,共4页
Clinical Research and Practice
关键词
中低位直肠癌
左结肠动脉
腹腔镜
全直肠系膜切除术
middle and low rectal cancer
left colic artery
laparoscope
total mesorectal excision
