保留左结肠动脉在直肠癌患者腹腔镜下直肠癌根治术（Dixon术）中的应用

Application of preserving left colon artery in laparoscopic radical resection of rectal cancer (Dixon) in patients with rectal cancer

摘要:

目的 探讨在腹腔镜下直肠癌根治术（Dixon术）中采用低位切除保留左结肠动脉（LCA）的临床应用价值。方法 回顾性分析2017年1月－2021年1月该院收治的98例行Dixon术的直肠癌患者的病例资料，根据术中是否保留LCA分为观察组（n = 53）和对照组（n = 45）。观察组采用低位结扎肠系膜下动脉（IMA）保留LCA治疗，对照组采用高位结扎IMA不保留LCA治疗。比较两组患者术中、术后并发症的发生率，以及复发和转移情况。结果 两组患者手术时间、术中出血量、术后排气时间、淋巴结清扫总数、阳性淋巴结数、No.253组淋巴结清扫数和预防性造口比较，差异均无统计学意义（P > 0.05）。观察组住院时间为（10.38±1.26）d，明显短于对照组的（11.06±1.31）d，两组患者比较，差异有统计学意义（P < 0.05）。观察组术后并发症发生率为5.66%，明显低于对照组的31.11%，两组患者比较，差异有统计学意义（P < 0.05）。两组患者术后复发率、转移率及累积生存率比较，差异均无统计学意义（P > 0.05）。结论 保留LCA的腹腔镜下Dixon术可以达到和高位切除同样程度的淋巴结清除，同时降低了吻合口瘘发生率，缩短了住院时间。

Abstract:

Objective To explore clinical application value of preserving left colon artery (LCA) by low resection in laparoscopic radical resection of rectal cancer (Dixon) in patients with rectal cancer.Methods Clinical data of 98 rectal cancer patients who underwent radical resection from January 2017 to January 2021 were retrospectively analyzed. According to presence or absence of intraoperative LCA preserving, they were divided into observation group (n = 53) and control group (n = 45). The observation group was treated with low ligation of inferior mesenteric artery (IMA) to preserve LCA, while control group was treated with high ligation of IMA to not preserve LCA. The occurrence, recurrence and metastasis of intraoperative and postoperative complications were compared between the two groups.Results The operation time, intraoperative blood loss, postoperative exhaust time, total number of lymph node dissection, number of positive lymph nodes, number of lymph node dissection and preventive ileostomy were no significance between the two groups (P > 0.05). The hospitalization time in observation group [(10.38 ± 1.26) d] was shorter than that in control group [(11.06 ± 1.31) d)] (P < 0.05). The incidence of postoperative complications in observation group was 5.66%, lower than 31.11% in the control group (P < 0.05). The postoperative recurrence rate, metastasis rate or cumulative survival rate were no significance between the two groups (P > 0.05).Conclusion The lymph node dissection effect of both laparoscopic Dixon with LCA preservation and high resection is comparable. Besides, the former can reduce the incidence of anastomotic leakage and shorten hospitalization time of patients.