腹腔镜下保留左结肠动脉直肠癌低位前切除术的临床研究

林洪坦 陈燊 刘燕雄

【摘要】 目的：探讨腹腔镜下直肠癌低位前切除术中保留左结肠动脉（left colonic artery，LCA）的可行性及临床应用价值。方法：选取笔者所在医院2016年3月-2017年3月肿瘤外科住院治疗的80例直肠癌患者，将其随机分为观察组和对照组，各40例。观察组行腹腔镜下保留LCA直肠癌低位前切除术，对照组行腹腔镜下不保留LCA直肠癌低位前切除术。比较两组手术指标及术后并发症发生情况。结果：观察组第3站淋巴结清扫数目（2.25±1.01）个，少于对照组的（2.35±1.08）個，但两组比较差异无统计学意义（P>0.05）。观察组手术时间（151.50±11.86）min，长于对照组的（124.40±5.41）min，术中出血量（56.00±9.21）ml，多于对照组的（51.00±11.05）ml，差异均有统计学意义（P<0.05）。观察组术后并发症发生率为5.0%，低于对照组的22.5%，差异有统计学意义（P<0.05）。结论：腹腔镜下保留LCA直肠癌低位前切除术可以在安全彻底清扫第3站淋巴结的前提下，降低术后并发症发生率，近期疗效较好。

【关键词】 左结肠动脉 腹腔镜 低位前切除术 肠系膜下动脉

doi：10.14033/j.cnki.cfmr.2019.28.011 文献标识码 B 文章编号 1674-6805（2019）28-00-03

Clinical Study of Laparoscopic Low Anterior Resection of Rectal Cancer with Left Colonic Artery Preservation/LIN Hongtan， CHEN Shen， LIU Yanxiong. //Chinese and Foreign Medical Research， 2019， 17（28）： -29

[Abstract] Objective： To discuss the feasibility and clinical application value of preservation of the left colonic artery（LCA） in laparoscopic low anterior resection of rectal cancer. Method： A total of 80 patients with rectal cancer hospitalized in the department of oncology in our hospital from March 2016 to March 2017 were selected and randomly divided into the observation group and the control group， with 40 cases in each group. The observation group underwent laparoscopic low anterior resection of rectal cancer with LCA preservation， while the control group underwent laparoscopic low anterior resection of rectal cancer without LCA preservation. The operative indexes and postoperative complications were compared between the two groups. Result： The number of third node lymph node dissection in the observation group was （2.25±1.01）， which was less than （2.35±1.08） in the control group， but the difference between the two groups was not statistically significant （P>0.05）. The operation time of the observation group was （151.50±11.86） min， which was longer than （124.40±5.41） min of the control group， and the amount of bleeding during the operation was （56.00±9.21） ml， which was more than （51.00±11.05） ml of the control group， the differences were statistically significant （P<0.05）.The incidence of postoperative complications was 5.0% in the observation group， which was lower than 22.5% in the control group， the difference was statistically significant （P<0.05）. Conclusion： Laparoscopic low anterior resection of rectal cancer with LCA preservation can reduce the incidence of postoperative complications under the premise of safe and thorough lymph node cleaning in the third station. The short-term effect is better.

[Key words] Left colonic artery Laparoscope Low anterior resection Inferior mesenteric arteriae

First-authors address： Sanming First Hospital Affiliated to Fujian Medical University， Sanming 365000， China

直肠癌（rectal carcinoma）是最常见的消化道恶性肿瘤之一[1-2]。近年来，由于人们饮食习惯的变化及人口老龄化的发展，其发病率和死亡率呈逐年上升趋势。然而，其治疗方式仍然是以手术切除为主，但手术方式的选择对患者的康复及远期预后有着较大的影响，传统手术多采用肠系膜下动脉（inferior mesenteric arteriae，IMA）根部高位结扎，未保留左结肠动脉（left colic artery，LCA）。随着人们认识的逐步提高，以及腹腔镜技术的广泛应用，使得保留LCA、低位结扎IMA这一术式得到推广。本研究探讨笔者所在医院2016年3月-2017年3月收治的80例直肠癌患者，对保留LCA直肠癌低位前切除术可行性及临床应用价值进行比较分析，现报道如下。

1 资料与方法

1.1 一般资料

选取笔者所在医院2016年3月-2017年3月肿瘤外科住院治疗的直肠癌患者80例，纳入标准：（1）术前经肠镜活检病理确诊;（2）肿瘤距肛缘5～8 cm。排除……