临床外科杂志 ›› 2019, Vol. 27 ›› Issue (5): 400-403.doi: 10.3969/j.issn.1005-6483.2019.05.014

• 论著 • 上一篇    下一篇

腹腔镜直肠癌前切除术中保留左结肠动脉对术后吻合口漏及近期疗效的影响

  

  1. 南京,东南大学附属中大医院江北院区(南京市大厂医院)普外科
  • 出版日期:2019-05-20 发布日期:2019-05-20

Influence of preserving left colic artery during during laparoscopic anterior resection for rectal cancer on anastomotic leakage and recent efficacy

  • Online:2019-05-20 Published:2019-05-20

摘要: 目的:探讨腹腔镜直肠癌前切除术中保留左结肠动脉(LCA)对病人术后吻合口漏及近期疗效的影响。方法:腹腔镜直肠癌前切除术病人100例,根据手术方式分为两组,观察组44例,保留LCA低位结扎肠系膜下动脉(IMA),对照组56例,不保留LCA。比较两组病人术后病理检查结果、围手术期指标、术后并发症发生情况,术前及术后6、12个月测定血清抗血管生成趋化因子CXCL9、可溶性E选择素(sEselectin)、癌胚抗原(CEA)、糖类抗原199(CA199),统计1年和3年复发转移率和生存率。结果:两组一般资料及术后病理资料(第3站淋巴结转移率、病理类型、TNM分期)比较,差异无统计学意义(P>0.05)。观察组与对照组的淋巴结清扫数分别为(12.44±1.92)枚和(12.61±2.23)枚,手术时间分别为(130.59±17.48)小时和(128.06±16.11)小时,术中出血量分别为(74.85±14.69)ml和(77.43±16.86)ml,两组比较差异均无统计学意义(P>0.05);观察组与对照组的术后排气时间分别为(72.53±1.79)小时和(76.11±2.82)小时,住院时间分别为(5.66±0.45)天和(6.22±0.53)天,差异有统计学意义(P<0.05)。观察组切口感染、肠梗阻、尿潴留、性功能障碍、控便不佳发生率分别为0.00、2.27%、4.55%、2.27%、2.27%,对照组分别为3.57%、3.57%、7.14%、3.57%、8.93%,差异无统计学意义(P>0.05);观察组无吻合口漏发生,对照组为10.71%,差异有统计学意义(P<0.05)。术后6、12个月,两组血清CXCL9、sEselectin、CEA、CA199水平均低于术前(P<0.05),但组间比较差异无统计学意义(P>0.05)。术后1、3年,观察组复发转移率分别为4.55%、20.45%,对照组分别为3.57%和19.64%,两组比较差异无统计学意义(P>0.05);观察组总生存率分别为97.73%、84.09%,对照组分别为100.00%和85.71%,差异无统计学意义(P>0.05)。结论:腹腔镜直肠癌前切除术中保留LCA有利于保护吻合口近端血运,降低术后吻合口漏发生率,且不增加手术难度及术后复发转移风险。

关键词: 腹腔镜直肠癌前切除术, 直肠癌, 左结肠动脉, 吻合口漏, 近期疗效

Abstract: Objective:To explore the influence of preserving left colic artery(LCA)during during laparoscopic anterior resection for rectal cancer on anastomotic leakage and recent efficacy.Methods:The clinical data of 138 patients undergoing laparoscopic anterior resection for rectal cancer r were retrospectively analyzed.The patients were divided into two groups according to the operation method:62 patients with preservation of LCA with low ligation of the inferior mesenteric artery(IMA)as the observation group,76 patients without preservation of LCA and high ligation of the IMA as control group.The general data,postoperative pathological findings,perioperative indicators,and postoperative complications were compared between the two groups.Serum antiangiogenic chemokine CXCL9,soluble E selectin(sEselectin),carcinoembryonic antigen(CEA)and carbohydrate antigen 199(CA199)were measured before and 6,12 months after surgery.All were followed up for 3 years to report recurrence and metastasis.Results:There was no significant differences in general data and postoperative pathological findings(3rd station lymph node metastasis rate,pathological type,TNM staging)between the two groups(P>0.05).There was no significant difference in the number of lymph node diss ections [(12.44±1.92)vs(12.61±2.23)],operation time [(130.59±17.48)h vs(128.06±16.11)h],intraoperative blood loss [(74.85±14.69)ml vs(77.43±16.86)ml] between the observation group and the control group(P>0.05),while the difference of postoperative exhaust time [(72.53±1.79)h vs(76.11±2.82)h] and the postoperative hospital stay[(5.66±0.45)d vs(6.22±0.53)d] between the two groups was significant(P<0.05).There was no significant differences in incision infection(0 vs 3.57%),intestinal obstruction(2.27% vs 3.57%),urinary retention(4.55% vs 7.14%),sexual dysfunction(2.27% vs 3.57%),poor stool control(2.27% vs 8.93%)between the observation group and the control group(P>0.05),while the difference of anastomotic leakage(0 vs 10.71%)between the two groups was significant(P<0.05).At 6 and 12 months after operation,the serum levels of CXCL9,sEselectin,CEA and CA199 were significantly lower than before operation(P<0.05),but there were no significant differences between the two groups(P>0.05).At 1 and 3 years after surgery,the recurrence and metastasis rates in the observation group were 4.55% and 20.45% respectively,which were not statistically different with 3.57% and 19.64% in the control group(P>0.05).The overall survival rate in the observation group was 97.73% and 84.09%,which were not statistically different with 100.00% and 85.71% in the control group(P>0.05).Conclusion:Preserving LCA during laparoscopic anterior resection of rectal cancer is beneficial to protect blood flow in the proximal anastomosis and reduce the incidence of postoperative anastomotic leakage,without increasing the difficulty of surgery and the risk of postoperative recurrence and metastasis.

Key words: laparoscopic anterior resection for rectal cancer, rectal cancer, left colonic artery, anastomotic fistula, shortterm efficacy

[1] 罗志民, 张家驹, 赵恩宏. 全身炎性反应与直肠癌术后生存率的相关分析[J]. 临床外科杂志, 2019, 27(5): 395-398.
[2] 秦新裕, 许剑民, 任黎, 常文举. 2018版《中国结直肠癌肝转移诊断和综合治疗指南》解读[J]. 临床外科杂志, 2019, 27(1): 9-13.
[3] 黄侃 刘松 陈宝俊. 食管癌根治术后吻合口漏的危险因素分析[J]. 临床外科杂志, 2018, 26(9): 671-673.
[4] 马人杰 贺琦 张海伟 张俊华 郑荣. 腹腔镜完全腹膜外补片植入术治疗腹股沟疝的近期疗效及安全性观察[J]. 临床外科杂志, 2018, 26(11): 862-864.
[5] 饶慕圣 曹胜华 王学成. 肛管直肠恶性黑色素瘤一例[J]. 临床外科杂志, 2018, 26(11): 891-891.
[6] . 中低位直肠癌新辅助治疗的个体化选择[J]. 临床外科杂志, 2018, 26(10): 733-734.
[7] 曹金鹏 杨平余思 李志澄 朱佳成 罗特东 计勇. 不同微创术式治疗高龄直肠癌病人的疗效及对其免疫炎性反应及预后的影响分析[J]. 临床外科杂志, 2018, 26(10): 751-753.
[8] 任朋 张烨 陶建新 沈仁辉 王彤. 吲哚菁绿显像对减少腹腔镜结直肠癌根治术后吻合口漏的作用[J]. 临床外科杂志, 2018, 26(10): 754-756.
[9] 赵家运 王志刚 潘乐玉. 限制性输血对直肠癌保肛术后并发症影响分析[J]. 临床外科杂志, 2018, 26(10): 763-766.
[10] 陶俊 王贵和. 局部进展期直肠癌新辅助放化疗后病理完全缓解的预测因素分析[J]. 临床外科杂志, 2018, 26(10): 756-759.
[11] 张文斌 李翔. 手辅助腹腔镜在肥胖结直肠癌患者中的应用价值及疗效分析[J]. 临床外科杂志, 2018, 26(10): 760-763.
[12] 欧文权 官国先. 经括约肌间切除治疗低位直肠癌保肛术的研究进展[J]. 临床外科杂志, 2018, 26(10): 797-799.
[13] 胡俊杰 熊治国. 肿瘤细胞减灭术联合腹腔热灌注化疗在结直肠癌腹膜转移中的应用现状及前景[J]. 临床外科杂志, 2018, 26(10): 727-730.
[14] 沈毅 涂从银 何磊. 损伤控制理念在结直肠癌穿孔中的应用 [J]. 临床外科杂志, 2013, 21(5): 357-359.
[15] 郭树军 张春旭 王全晖等. 腹腔镜经腹会阴低位直肠癌柱状切除及阔筋膜盆底重建的应用(附16例报告) [J]. 临床外科杂志, 2013, 21(4): 277-278.
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