关键词: 直肠癌根治术, 左结肠动脉, 吻合口瘘, 直肠癌

Abstract: Objective To investigate the effect of preserving the left colic artery (LCA) in radical rectal cancer surgery on the incidence of postoperative anastomotic fistula and short-term prognosis.Methods The clinical data of 113 patients who underwent radical rectal cancer surgery in our hospital from March 2020 to December 2024 were retrospectively analyzed, and the patients were divided into the preserved group (n=42) and the non-preserved group (n=71) based on whether the LCA was preserved or not.The non-preserved group carried out the direct high ligation of the inferior mesenteric artery (IMA), and the preserved group carried out the preserved LCA low ligation.The clinical data, perioperative indexes, and the incidence of anastomotic fistula and postoperative complications within 3 months after surgery were compared between the two groups.The risk factors for postoperative anastomotic fistula events in the two groups were analyzed by Logistic regression, and their predictive efficacy was analyzed by ROC curves.Results The number of patients with complicated chronic diseases in the non-preserved group(26.76%, 19 cases) was higher than that in the preserved group(9.52%, 4 cases) (P<0.05), while the comparison of the rest of the general clinical data was not statistically significant(P＞0.05).The length of postoperative hospitalization in the nonpreserved group was significantly higher than that in the preserved group (P<0.05), whereas there was no significant difference in the length of surgery, laparoscopic surgery, intraoperative bleeding, and the number of lymphatic dissections between the two groups.The postoperative CRP, leukocyte level, and the incidence of postoperative complications were significantly higher in the non-preserved group than in the preserved group (P<0.05).The regression results showed that tumor length diameter, distance from the anal verge, leukocytes, preserved LCA, and TNM stage were risk factors for the development of anastomotic fistula.The results of the ROC curve showed that the AUC of tumor length diameter, distance from the anal verge, leukocytes, preserved LCA, TNM staging, and combined index were 0.80, 0.75, 0.86, 0.65, 0.64, and 0.89, respectively, and the predictive efficacy of the combined index was better than that of the single index (P<0.05).Conclusion Preservation of LCA reduces the risk of complications and anastomotic fistula after radical surgery for rectal cancer, and tumor length diameter, distance from the anal verge, leukocytes, TNM stage, and failure to preserve LCA are risk factors for anastomotic fistula, and the combined index prognostic efficacy is better.

Key words: radical rectal cancer, left colonic artery, anastomotic fistula, rectal cancer