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

doi:10.3969/j.issn.1006-6233.2023.02.024

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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.

Key words： Rectal cancer Left colonic artery Lymph node dissection Anal function Complications

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2023.02.024 OR http://www.hbyxzzs.cn/EN/Y2023/V29/I2/302

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