保留盆腔自主神经联合左结肠动脉的腹腔镜直肠癌根治术在直肠癌治疗中的应用效果

Application effect of laparoscopic radical resection of rectal cancer with pelvic autonomic nerve preservation and left colic artery preservation in the treatment of rectal cancer

摘要:

目的 探究保留盆腔自主神经（PAN）联合左结肠动脉（LCA）的腹腔镜直肠癌（RC）根治术的治疗效果。方法 回顾性分析2020年6月－2024年6月于该院行腹腔镜RC根治术的124例患者的临床资料，根据不同手术方式分为：对照组、保留PAN组、保留LCA组、保留PAN和LCA组，各31例。比较4组患者手术相关指标、血清黏附分子、吻合口血流灌注及术后并发症发生情况。结果 保留PAN和LCA组的术后首次排气时间和住院时间较其余3组短，淋巴结清扫数量较其余3组多，结肠边缘动脉弓压力（MASP）较其余3组高，并发症总发生率较其余3组低，差异均有统计学意义（P < 0.05）；术后6个月，保留PAN和LCA组的CD44v6、细胞间黏附分子-1（ICAM-1）和血管细胞黏附分子-1（VCAM-1）较其余3组低，上皮钙黏素（E-cadherin）水平较其余3组高，差异均有统计学意义（P < 0.05）；肠系膜下动脉（IMA）结扎后，4组患者收缩期峰值流速（PSV）和舒张末期流速（EDV）较IMA结扎前降低，术毕时均有所回升，且保留PAN和LCA组在结扎后和术毕时较其余3组高，差异均有统计学意义（P < 0.05）。结论 保留PAN联合LCA的腹腔镜RC根治术在RC治疗中的效果更佳，血清黏附分子和吻合口血流灌注水平能够得到明显改善，且能够降低术后并发症的发生率。

Abstract:

Objective To explore the application effect of laparoscopic radical resection of rectal cancer (RC) with pelvic autonomic nerve (PAN) preservation and left colic artery (LCA) preservation in the treatment of RC.Methods A retrospective collection was conducted on 124 patients who underwent laparoscopic radical resection of RC in our hospital from June 2020 to June 2024. They were divided into the control group, the PAN group, the LCA group, and the PAN + LCA group according to the surgical method, each having 31. The surgical related indicators, serum adhesion molecules, anastomotic perfusion, and postoperative complications were compared among the four groups.Results The PAN + LCA group had the shortest postoperative first exhaust time and hospital stay, the highest number of lymph node dissections, colonic marginal artery stump pressure (MASP), and the lowest total incidence of complications, the differences were statistically significant (P < 0.05). Six months after surgery, the PAN + LCA group had the lowest CD44v6, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and the highest E-cadherin (P < 0.05). After inferior mesenteric artery (IMA) ligation, the peak systolic velocity (PSV) and end diastolic velocity (EDV) in all four groups decreased, and all showed some recovery at the end of the operation. The PAN + LCA group had the highest values after ligation and after surgery (P < 0.05).Conclusion Laparoscopic radical resection of RC with PAN and LCA preservation is more effective in patients with RC. Serum adhesion molecules and anastomotic perfusion can be clearly improved, and the incidence of postoperative complications can be reduced.