肠系膜下动脉在腹腔镜直肠癌根治术中的处理方式及保留左结肠动脉的临床意义
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摘要
目的:探讨腹腔镜直肠癌根治术中保留左结肠动脉(LCA)的临床应用价值及意义。方法:回顾分析2016年3月至2018年2月为56例患者行腹腔镜直肠癌根治术的临床资料,患者分为低位结扎组(n=28,保留LCA)与高位结扎组(n=28,不保留LCA),比较两组患者术前CEA值、手术时间、术中出血量、淋巴结清扫数量、肠系膜下动脉(IMA)根部淋巴结(253组)清扫数量、IMA根部淋巴结转移率、术后肛门首次排气时间、术后恢复自主排尿时间、吻合口漏发生率等指标。结果:两组患者术前CEA值、手术时间、术中出血量、淋巴结清扫数量、IMA根部淋巴结清扫数量、IMA根部淋巴结转移率、术后恢复自主排尿时间差异无统计学意义(P>0.05);低位结扎组术后肛门首次排气时间、吻合口漏发生率优于高位结扎组,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既可达到彻底清扫淋巴结的目的,又能有效保障肠管血供,降低吻合口漏发生率,促进肛门早期排气,安全、可靠,具有良好的临床应用前景。
Objective:To investigate the application value and clinical significance of the technique of retaining left colonic artery(LCA) in laparoscopic radical resection of rectal cancer.Methods:The clinical data of 56 cases of laparoscopic rectal cancer radical resection from Mar.2016 to Feb.2018 were retrospectively analyzed.Patients were divided into the low ligation group(n=28,LCA was reserved) and the high ligation group(n=28,LCA was not reserved).The indicators of the two groups were compared,including preoperative CEA value,operation time,intraoperative blood loss,number of lymph node harvested,number of resected lymph node at inferior mesenteric artery(IMA) root(253 group),metastasis rate of IMA root lymph node,postoperative anus exhaust time for the first time,postoperative recovery of spontaneous urination time,anastomotic leakage incidence and so on.Results:There were no significant differences in preoperative CEA,operative time,intraoperative blood loss,number of lymph node harvested,number of IMA root lymph node harvested,IMA root lymph node metastasis incidence,or postoperative recovery of spontaneous urination(P>0.05).The first time of postoperative anus exhaust and the incidence of anastomotic leakage in the low ligation group were significantly better than those in the high ligation group(P<0.05).Conclusions:Retention LCA during laparoscopic radical resection of rectal cancer can not only achieve the purpose of thorough cleaning lymph nodes,but also effectively protect the blood supply of intestine,reduce the incidence of anastomotic leakage,and promote early anal exhaust.This technology is safe,reliable and has good clinical application prospects.
Objective:To investigate the application value and clinical significance of the technique of retaining left colonic artery(LCA) in laparoscopic radical resection of rectal cancer.Methods:The clinical data of 56 cases of laparoscopic rectal cancer radical resection from Mar.2016 to Feb.2018 were retrospectively analyzed.Patients were divided into the low ligation group(n=28,LCA was reserved) and the high ligation group(n=28,LCA was not reserved).The indicators of the two groups were compared,including preoperative CEA value,operation time,intraoperative blood loss,number of lymph node harvested,number of resected lymph node at inferior mesenteric artery(IMA) root(253 group),metastasis rate of IMA root lymph node,postoperative anus exhaust time for the first time,postoperative recovery of spontaneous urination time,anastomotic leakage incidence and so on.Results:There were no significant differences in preoperative CEA,operative time,intraoperative blood loss,number of lymph node harvested,number of IMA root lymph node harvested,IMA root lymph node metastasis incidence,or postoperative recovery of spontaneous urination(P>0.05).The first time of postoperative anus exhaust and the incidence of anastomotic leakage in the low ligation group were significantly better than those in the high ligation group(P<0.05).Conclusions:Retention LCA during laparoscopic radical resection of rectal cancer can not only achieve the purpose of thorough cleaning lymph nodes,but also effectively protect the blood supply of intestine,reduce the incidence of anastomotic leakage,and promote early anal exhaust.This technology is safe,reliable and has good clinical application prospects.
引文
[1] 闾仁,黄盛,张再重,等.腹腔镜下低位结扎肠系膜下动脉的Dixon观察[J].现代临床医学,2014,40(1):17-19.
[2] 胡建昆,赵林勇.腹腔镜胃癌根治联合脏器切除的现状与发展[J/CD].中华普外科手术学杂志(电子版),2017,11(6):457-460.
[3] 宗亚光,王夫景,徐训政.全直肠系膜切除根治术中保留左结肠动脉的临床疗效观察[J].结直肠肛门外科,2017,23(2):154-157.
[4] 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):660-663.
[5] 王小刚,高晓峰,杨维桢.腹腔镜下右半结肠癌根治术与传统开腹中线入路的随机对照观察[J].结直肠肛门外科,2016,22(2):188-191.
[6] 黄榕康,何丹丹,赵洁,等.直肠癌保留括约肌术后预防性回肠造口回纳术后并发症的危险因素分析[J].中国普外基础与临床杂志,2016,23(11):1335-1338.
[7] Nash GM.Lymph node yield and oncologic outcome after colorectal cancer resection[J].Ann Surg Oncol,2012,19(7):2084-2085.
[8] Benson AB 3rd,Venook AP,Bekaii-Saab T,et al.Rectal Cancer,Version 2.2015[J].J Natl Compr Canc Netw,2015,13(6):719-728.
[9] Kawamura YJ,Sakuragi M,Togashi K,et al.Distribution of lymph node metastasis in T1 sigmoid colon carcinoma:should we ligate the inferior mesenteric artery?[J].Scand J Gastroenterol,2005,40(7):858-861.
[10] Shiomi A,Ito M,Maeda K,et al.Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer:a propensity score matching analysis of 1,014 consecutive patients[J].J Am Coll Surg,2015,220(2):186-194.
[11] Enker WE,Thaler HT,Cranor ML,et al.Total mesorectal excision in the operative treatment of carcinoma of the rectum[J].J Am Coll Surg,1995,181(4):335-346.
[12] Chew MH,Yeh YT,Lim E,et al.Pelvic autonomic nerve preservation in radical rectal cancer surgery:changes in the past 3 decades[J].Gastroenterol Rep (Oxf),2016,4(3):173-185.
[13] 申占龙,叶颖江,王杉.直肠癌全直肠系膜切除术中盆腔植物神经的易损区域及保护[J/CD].中华结直肠疾病电子杂志,2018,7(1):8-11.
[14] 张海永,杨鹏远,兰海生,等.以盆腔自主神经为解剖标识的腹腔镜低位直肠癌根治术对男性患者术后排尿、性功能影响的研究[J].结直肠肛门外科,2018,24(1):22-26.
[15] 赵松,童卫东.预置肛管在防治直肠癌术后吻合口瘘的作用[J].中华胃肠外科杂志,2016,19(6):714-717.
[16] Kulu Y,Tarantio I,Warschkow R,et al.Anastomotic leakage is associated with impaired overall and disease-free survival after curative rectal cancer resection:a propensity score analysis[J].Ann Surg Oncol,2015,22(6):2059-2067.
[17] Qin Q,Ma T,Deng Y,et al.Impact of Preoperative Radiotherapy on Anastomotic Leakage and Stenosis After Rectal Cancer Resection:Post Hoc Analysis of a Randomized Controlled Trial[J].Dis Colon Rectum,2016,59(10):934-942.
[18] 沈荐,李敏哲,杜燕夫,等.保留左结肠动脉的腹腔镜直肠癌低位前切除术的长期疗效分析[J].中华胃肠外科杂志,2017,20(6):660-664.
[19] 谢泽民,章社民.保留左结肠动脉的腹腔镜直肠癌前切除术的临床疗效[J].中国临床保健杂志,2015,18(2):202-204.
[2] 胡建昆,赵林勇.腹腔镜胃癌根治联合脏器切除的现状与发展[J/CD].中华普外科手术学杂志(电子版),2017,11(6):457-460.
[3] 宗亚光,王夫景,徐训政.全直肠系膜切除根治术中保留左结肠动脉的临床疗效观察[J].结直肠肛门外科,2017,23(2):154-157.
[4] 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):660-663.
[5] 王小刚,高晓峰,杨维桢.腹腔镜下右半结肠癌根治术与传统开腹中线入路的随机对照观察[J].结直肠肛门外科,2016,22(2):188-191.
[6] 黄榕康,何丹丹,赵洁,等.直肠癌保留括约肌术后预防性回肠造口回纳术后并发症的危险因素分析[J].中国普外基础与临床杂志,2016,23(11):1335-1338.
[7] Nash GM.Lymph node yield and oncologic outcome after colorectal cancer resection[J].Ann Surg Oncol,2012,19(7):2084-2085.
[8] Benson AB 3rd,Venook AP,Bekaii-Saab T,et al.Rectal Cancer,Version 2.2015[J].J Natl Compr Canc Netw,2015,13(6):719-728.
[9] Kawamura YJ,Sakuragi M,Togashi K,et al.Distribution of lymph node metastasis in T1 sigmoid colon carcinoma:should we ligate the inferior mesenteric artery?[J].Scand J Gastroenterol,2005,40(7):858-861.
[10] Shiomi A,Ito M,Maeda K,et al.Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer:a propensity score matching analysis of 1,014 consecutive patients[J].J Am Coll Surg,2015,220(2):186-194.
[11] Enker WE,Thaler HT,Cranor ML,et al.Total mesorectal excision in the operative treatment of carcinoma of the rectum[J].J Am Coll Surg,1995,181(4):335-346.
[12] Chew MH,Yeh YT,Lim E,et al.Pelvic autonomic nerve preservation in radical rectal cancer surgery:changes in the past 3 decades[J].Gastroenterol Rep (Oxf),2016,4(3):173-185.
[13] 申占龙,叶颖江,王杉.直肠癌全直肠系膜切除术中盆腔植物神经的易损区域及保护[J/CD].中华结直肠疾病电子杂志,2018,7(1):8-11.
[14] 张海永,杨鹏远,兰海生,等.以盆腔自主神经为解剖标识的腹腔镜低位直肠癌根治术对男性患者术后排尿、性功能影响的研究[J].结直肠肛门外科,2018,24(1):22-26.
[15] 赵松,童卫东.预置肛管在防治直肠癌术后吻合口瘘的作用[J].中华胃肠外科杂志,2016,19(6):714-717.
[16] Kulu Y,Tarantio I,Warschkow R,et al.Anastomotic leakage is associated with impaired overall and disease-free survival after curative rectal cancer resection:a propensity score analysis[J].Ann Surg Oncol,2015,22(6):2059-2067.
[17] Qin Q,Ma T,Deng Y,et al.Impact of Preoperative Radiotherapy on Anastomotic Leakage and Stenosis After Rectal Cancer Resection:Post Hoc Analysis of a Randomized Controlled Trial[J].Dis Colon Rectum,2016,59(10):934-942.
[18] 沈荐,李敏哲,杜燕夫,等.保留左结肠动脉的腹腔镜直肠癌低位前切除术的长期疗效分析[J].中华胃肠外科杂志,2017,20(6):660-664.
[19] 谢泽民,章社民.保留左结肠动脉的腹腔镜直肠癌前切除术的临床疗效[J].中国临床保健杂志,2015,18(2):202-204.