Abstract：Objective: To explore the effect of preserving the left colonic artery (LCA) during laparoscopic low anterior resection on patients with rectal cancer. Methods: The clinical data of 85 patients undergoing laparoscopic low anterior resection of rectal cancer in the hospital between April 2018 and February 2021 were retrospectively analyzed. According to different treatment methods, the patients were divided into the observation group (LCA preservation, n=40) and the control group (LCA non-preservation, n=45). The surgery-related indicators, postoperative recovery status, as well as gastrointestinal motility indicators, and anal function (Wexner constipation score) before and after surgery, were compared between the two groups. The recurrence and metastasis of the two groups were compared at 12 months of follow-up, and the postoperative complications were recorded. Results: The surgical time in the observation group was lengthened compared with that in the control group (P<0.05), and there were no statistical differences in the intraoperative blood loss, the total number of dissected lymph nodes, the number of dissected lymph nodes in group 253, ischemic changes of the stump during surgery and the number of prophylactic stomata between both groups (P>0.05). The postoperative first exhaust time and hospital stay were markedly shorter in the observation group compared to the control group (P<0.05), and there was no statistical significance in the fluid intake time (P>0.05). After surgery, the levels of serum MTL and GAS in the two groups were significantly reduced compared to before surgery (P<0.05) while the Wexner constipation score was significantly enhanced compared with before surgery (P<0.05), but there were no statistical significant differences in the changes of the above indicators before and after treatment between the two groups (P>0.05). During 12 months of follow-up, there was 1 case of local recurrence and 2 cases of liver metastasis in the observation group and 3 cases of local recurrence and 3 cases of liver metastasis in the control group, and the differences in the incidence rates of recurrence and metastasis were not statistically significant (P>0.05). During the 12-month follow-up, there were no statistical differences in the incidence rates of complications such as anastomotic leakage, anastomotic bleeding, and urinary tract infection between the two groups (P>0.05). Conclusion: LCA preservation during laparoscopic low anterior resection does not affect the gastrointestinal function and lymph node dissection and can shorten postoperative exhaust time and hospital stay, and it has the same efficacy in recurrence and metastasis as that without preservation of LCA.
陈小保, 梅天明, 魏俊, 柳长青, 章涛. 腹腔镜下低位前切除术中保留左结肠动脉对直肠癌患者疗效及预后的影响[J]. 河北医学, 2023, 29(2): 302-306.
CHEN Xiaobao, MEI Tianming, WEI Jun, et al. Effect of Preserving the Left Colonic Artery during Laparoscopic Low Anterior Resection on the Outcome and Prognosis of Patients with Rectal Cancer. HeBei Med, 2023, 29(2): 302-306.
[1] Quezada-Diaz FF,Smith JJ.Neoadjuvant therapy for rectal cancer [J].Surg Oncol Clin N Am,2022,31(2):279-291. [2] Draginov A,Chesney TR,Quereshy HA,et al.Association of high ligation versus low ligation of the inferior mesenteric artery on anastomotic leak,postoperative complications,and mortality after minimally invasive surgery for distal sigmoid and rectal cancer [J].Surg Endosc,2020,34(10):4593-4600. [3] Tang X,Zhang M,Wang C,et al.Preservation of the left colic artery and superior rectal artery in laparoscopic surgery can reduce anastomotic leakage in sigmoid colon cancer [J].Minim Access Surg,2021,17(2):208-212. [4] 国家卫生计生委医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2017年版)[J].中华外科杂志,2018,56(4):241-258. [5] 袁敏哲,姚长康,刘荣.腹腔镜与开腹手术治疗直肠癌对术后肛门功能、胃肠功能与血清胃肠激素的影响[J].结直肠肛门外科,2016,22(4):365-368. [6] Majidirad F,Hadian MR,Asl Soleimani H,et al.Cross-cultural adaptation,validity,and reliability of the Wexner questionnaire in patients with functional constipation in an Iranian population [J].Gastroenterol Hepatol Bed Bench,2021,14(3):243-249. [7] Sindhu RSN,Natesh B,Rajan R,et al.Low-tie IMA and selective D3 lymph node sampling in laparoscopic rectal resection for carcinoma rectum:comparison of surgical and oncological outcomes with the open technique [J].Gastrointest Oncol,2017,8(5):850-857. [8] 燕速,马新福,赵康,等.低位直肠癌常规行No.253淋巴结清扫的争议与共识[J].中国实用外科杂志,2020,40(3):315-322. [9] 周志翔,龚光伟,赵丹,等.腹腔镜下直肠癌前切除术中保留左结肠动脉的意义[J].腹部外科,2020,33(1):69-72. [10] 姜慧员,刘海义,江波,等.保留左结肠动脉在腹腔镜直肠癌前切除术中的临床应用和疗效观察[J].中华结直肠疾病电子杂志,2021,10(1):70-75. [11] Komen N,Slieker J,de Kort P,et al.High tie versus low tie in rectal surgery:comparison of anastomotic perfusion [J].Int Colorectal Dis,2011,26(8):1075-1078. [12] Zhang C,Wei HT,Hu W,et al.The feasibility of laparoscopic TSME preserving the left colic artery and superior rectal artery for upper rectal cancer [J].World Surg Oncol,2020,18(1):212.
2023, Vol. 29 
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