广西医学

目的探讨保留左结肠动脉（LCA）联合根尖淋巴结清扫在腹腔镜下直肠癌根治术中的应用效果。方法选择130例接受腹腔镜下直肠癌根治术治疗的直肠癌患者作为研究对象，根据是否保留LCA分为低位结扎组（LL组）64例和高位结扎组（HL组）66例，其中LL组采取保留LCA联合根尖淋巴结清扫术，HL组采取LCA切除术式。比较两组患者的手术情况、淋巴结清扫情况、术后恢复情况及术后1个月内早期并发症的发生情况。术后随访2年，比较两组患者的肿瘤局部复发情况和肝、肺等远处器官转移情况，以及生存率。结果LL组的手术时间长于HL组，低位直肠前切除综合征（LARS）发生率低于HL组（P＜0.05）；但两组的术中出血量、术中游离脾曲比例、淋巴结清扫总数、总淋巴结阳性率、No.253淋巴结清扫数、No.253淋巴结阳性率，以及术后吻合口漏、吻合口出血、术口感染、腹腔感染、肺部感染的发生率差异无统计学意义（P＞0.05）。术后随访2年，两组的肠道局部复发率、肝脏转移率及总体生存率差异无统计学意义（P＞0.05）。结论在腹腔镜下直肠癌根治术中保留LCA可降低患者术后LARS的发生率，但会延长手术时间，而是否保留LCA对直肠癌患者的淋巴结清扫及术后生存、复发情况并无太大影响。

ObjectiveTo explore the application effect of left colic artery (LCA)-preserving combined with apical lymph node dissection in laparoscopic radical resection of rectal cancer. MethodsA total of 130 patients with rectal cancer receiving therapy of laparoscopic radical resection of rectal cancer were selected as the research subjects, and they were assigned to low ligation group (LL group, n=64) or high ligation group (HL group, n=66) according to the presence of LCA-preserving, therein, the LL group employed LCA-preserving combined with apical lymph node dissection, while the HL group employed LCA resection. The surgical status, lymph node dissection status, postoperative recovery status, and occurrence of early complications within 1 month after surgery were compared between the two groups. Patients in both groups were followed up for 2 years, the local recurrence of tumor, metastasis of liver, lung, and other distant organs, as well as survival rate were compared between the two groups. ResultsThe operation duration of the LL group was longer than that of the HL group, whereas the incidence rate of low anterior rectal resection syndrome (LARS) of the LL group was lower than that of the HL group (P＜0.05); but there was no statistically significant difference in intraoperative bleeding volume, proportion of intraoperative free splenic flexure, total number of lymph node dissection, total positive rate of lymph nodes, number of No.253 lymph node dissection, and positive rate of No.253 lymph node, as well as postoperative incidence rates of anastomotic leakage, anastomotic bleeding, surgical wound infection, abdominal infection, pulmonary infection between the two groups (P＞0.05). After 2 years of postoperative follow-up, there was no statistically significant difference in the rate of intestinal local recurrence, metastasis rate of liver, and total survival rate between the two groups (P＞0.05).ConclusionLCA-preserving in laparoscopic radical resection of rectal cancer can decrease the incidence rate of postoperative LARS in patients, but it will prolong operation duration, whether preserving LCA or not has no significant effect on lymph node dissection, postoperative survival, and recurrence of rectal cancer patients.