左结肠动脉保留与腹腔镜直肠癌根治术后远期疗效的关系
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摘要
目的:探讨左结肠动脉保留与腹腔镜直肠癌根治术后远期疗效的关系。方法:收集2010年1月至2013年1月南阳市中心医院普通外科收治的行腹腔镜治疗的78例直肠癌患者的临床资料。其中,40例患者术中保留左结肠动脉,38例不保留。分析对比两组患者远期疗效的差异。结果:两组患者在性别、年龄、ASA评分、大体类型、组织学类型、TNM分期、肠系膜下动脉(IMA)根部淋巴结情况、体质指数、肿瘤距肛缘距离等方面的差异均无统计学意义(P> 0.05)。两组患者均手术顺利,无术中止血困难或粘连松解困难而中转开腹病例,无术中及围术期院内死亡病例。实验组患者手术时间、出血量、排气时间、住院天数与对照组相比,差异均无统计学意义(P> 0.05)。在预防性造口方面两组比较差异显著(P <0.05),两组吻合口瘘情况相比,差异无统计学意义(P> 0.05)。实验组40例患者死亡10例,5年生存率为75.0%(30/40)。对照组38例患者死亡11例,5年生存率为71.1%(27/38),Log-rank统计检验显示,两组患者的总体生存率差异无统计学意义(P=0.659)。结论:腹腔镜直肠癌根治术中保留左结肠动脉可在改善近端肠管血运和减少吻合口瘘的基础上,取得与肠系膜下动脉根部结扎切断相同的远期疗效,值得临床推广。
Objective: To investigate the relationship of curative effect between the left colon artery reservation and radical resection of rectal cancer.Methods: The clinical data of 78 patients with rectal cancer treated by laparoscopy in general surgery of Nanyang Central Hospital from January 2010 to January 2013 were collected.40 patients retained the left colic artery,and 38 cases were not reserved.The difference of long-term curative effect between the two groups was analysed.Results: In gender,age,ASA score,gross type,histological type,TNM stage,IMA lymph nodes,body mass index,tumor from the anal margin distance,there were no significant differences between the two groups(P> 0.05).Two groups of patients were successfully operated,without intraoperative hemostasis or loose adhesion,and converted to open surgery,without intraoperative or perioperative in-hospital death.In the experimental group,the operative time,the bleeding volume,the exhaust time,the number of days of hospitalization were not statistically significant than those in the control group(P > 0.05).There was significant difference in prophylactic stoma between the two groups(P < 0.05),but there was no significant difference in anastomotic leakage between the two groups(P> 0.05).The 5-year survival rate of the experimental group was 75%(30/40).The 5-year survival rate of the control group was 71.1%(27/38),and the Log-rank statistical test showed that there was no significant difference in the overall survival rate between the two groups(P = 0.659).Conclusion: Preservation of left colonic artery during laparoscopic resection of rectal cancer can improve proximal intestinal blood flow.On the basis of reducing anastomotic leakage,to obtain the same long-term effect as inferior mesenteric artery ligation and transection,it is worthy of clinical promotion.
Objective: To investigate the relationship of curative effect between the left colon artery reservation and radical resection of rectal cancer.Methods: The clinical data of 78 patients with rectal cancer treated by laparoscopy in general surgery of Nanyang Central Hospital from January 2010 to January 2013 were collected.40 patients retained the left colic artery,and 38 cases were not reserved.The difference of long-term curative effect between the two groups was analysed.Results: In gender,age,ASA score,gross type,histological type,TNM stage,IMA lymph nodes,body mass index,tumor from the anal margin distance,there were no significant differences between the two groups(P> 0.05).Two groups of patients were successfully operated,without intraoperative hemostasis or loose adhesion,and converted to open surgery,without intraoperative or perioperative in-hospital death.In the experimental group,the operative time,the bleeding volume,the exhaust time,the number of days of hospitalization were not statistically significant than those in the control group(P > 0.05).There was significant difference in prophylactic stoma between the two groups(P < 0.05),but there was no significant difference in anastomotic leakage between the two groups(P> 0.05).The 5-year survival rate of the experimental group was 75%(30/40).The 5-year survival rate of the control group was 71.1%(27/38),and the Log-rank statistical test showed that there was no significant difference in the overall survival rate between the two groups(P = 0.659).Conclusion: Preservation of left colonic artery during laparoscopic resection of rectal cancer can improve proximal intestinal blood flow.On the basis of reducing anastomotic leakage,to obtain the same long-term effect as inferior mesenteric artery ligation and transection,it is worthy of clinical promotion.
引文
[1]Park EJ,Cho MS,Baek SJ,et al.Long-term oncologic outcomes of robotic low anterior resection for rectal cancer:A comparative study with laparoscopic surgery[J].Annals of Surgery,2015,261(1):129-137.
[2]You Qing,Gong Hangjun,Han Gang,et al.Technique and experience of laparoscopic surgery for rectal cancer[J].Journal of Laparoscopic Surgery,2017,22(06):474-476.[游清,龚航军,韩刚,等.腹腔镜直肠癌手术相关持镜技巧及经验总结[J].腹腔镜外科杂志,2017,22(6):474-476.]
[3]Hall MD,Schultheiss TE,Smith DD,et al.Impact of total lymph node count on staging and survival after neoadjuvant chemoradiation therapy for rectal cancer[J].Annals of Surgical Oncology,2015,22(Suppl 3):580-587.
[4]Fleshman J,Branda M,Sargent DJ,et al.Effect of laparoscopicassisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes:The ACOSOG Z6051 randomized clinical trial[J].Jama,2015,314(13):1346-1355.
[5]Zang L,Ma J,Zheng M.Effect of preserving left colic artery during radical operation of rectal cancer on anastomotic leakage and operation time[J].Chinese Journal of Gastrointestinal Surgery,2016,19(4):386-389.
[6]Mei Lin,Yang Nianzhao,Kong Lingling,et al.Meta analysis of laparoscopic and open surgery in the treatment of advanced rectal cancer after neoadjuvant radiotherapy and chemotherapy[J].Journal of Laparoscopic Surgery,2017,22(7):515-522.[梅林,杨年钊,孔令令,等.新辅助放化疗后行腹腔镜手术与开腹手术治疗进展期直肠癌的meta分析[J].腹腔镜外科杂志,2017,22(7):515-522.]
[7]Malakorn S,Sammour T,Bednarski B,et al.Three different approaches to the inferior mesenteric artery during robotic D3 lymphadenectomy for rectal cancer[J].Annals of Surgical Oncology,2017,152(5):1-9.
[8]Guo Y,Wang D,He L,et al.Marginal artery stump pressure in left colic artery-preserving rectal cancer surgery:A clinical trial[J].ANZ Journal of Surgery,2015,52(8):11-16.
[9]Higashijima J,Shimada M,Iwata T,et al.New ports placement in laparoscopic central lymph nodes dissection with left colic artery preservation for sigmoid colon and rectal cancer[J].Journal of Medical Investigation,2015,62(3.4):223-227.
[10]Re GL,Galia M,Grassedonio E,et al.64-detector computed tomography in preoperative assessment of vascular anatomy of middle colic artery in left-sided colon cancer[J].ANZ Journal of Surgery,2014,81(10):870-872.
[11]Charan I,Kapoor A,Singhal MK,et al.High ligation of inferior mesenteric artery in left colonic and rectal cancers:Lymph node yield and survival benefit[J].Indian Journal of Surgery,2015,77(3):1103-1109.
[12]Zhang Yun,Gong Hangjun,Han Gang,et al.Clinical application of laparoscopic D3 lymph node dissection with superior rectal artery preservation in radical resection of descending colon and proximal sigmoid carcinoma[J].Journal of Laparoscopic Surgery,2017,22(3):180-184.[张云,龚航军,韩刚,等.腹腔镜保留直肠上动脉的D3淋巴结清扫术在降结肠、近段乙状结肠癌根治术中的临床应用[J].腹腔镜外科杂志,2017,22(3):180-184.]
[13]Elkased A,Elgammal A,Ammar M,et al.Apical lymph node dissection and low ligation of inferior mesenteric artery in the management of distal colorectal cancer[J].Original Crtucle,2016,35(3):298-304.
[2]You Qing,Gong Hangjun,Han Gang,et al.Technique and experience of laparoscopic surgery for rectal cancer[J].Journal of Laparoscopic Surgery,2017,22(06):474-476.[游清,龚航军,韩刚,等.腹腔镜直肠癌手术相关持镜技巧及经验总结[J].腹腔镜外科杂志,2017,22(6):474-476.]
[3]Hall MD,Schultheiss TE,Smith DD,et al.Impact of total lymph node count on staging and survival after neoadjuvant chemoradiation therapy for rectal cancer[J].Annals of Surgical Oncology,2015,22(Suppl 3):580-587.
[4]Fleshman J,Branda M,Sargent DJ,et al.Effect of laparoscopicassisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes:The ACOSOG Z6051 randomized clinical trial[J].Jama,2015,314(13):1346-1355.
[5]Zang L,Ma J,Zheng M.Effect of preserving left colic artery during radical operation of rectal cancer on anastomotic leakage and operation time[J].Chinese Journal of Gastrointestinal Surgery,2016,19(4):386-389.
[6]Mei Lin,Yang Nianzhao,Kong Lingling,et al.Meta analysis of laparoscopic and open surgery in the treatment of advanced rectal cancer after neoadjuvant radiotherapy and chemotherapy[J].Journal of Laparoscopic Surgery,2017,22(7):515-522.[梅林,杨年钊,孔令令,等.新辅助放化疗后行腹腔镜手术与开腹手术治疗进展期直肠癌的meta分析[J].腹腔镜外科杂志,2017,22(7):515-522.]
[7]Malakorn S,Sammour T,Bednarski B,et al.Three different approaches to the inferior mesenteric artery during robotic D3 lymphadenectomy for rectal cancer[J].Annals of Surgical Oncology,2017,152(5):1-9.
[8]Guo Y,Wang D,He L,et al.Marginal artery stump pressure in left colic artery-preserving rectal cancer surgery:A clinical trial[J].ANZ Journal of Surgery,2015,52(8):11-16.
[9]Higashijima J,Shimada M,Iwata T,et al.New ports placement in laparoscopic central lymph nodes dissection with left colic artery preservation for sigmoid colon and rectal cancer[J].Journal of Medical Investigation,2015,62(3.4):223-227.
[10]Re GL,Galia M,Grassedonio E,et al.64-detector computed tomography in preoperative assessment of vascular anatomy of middle colic artery in left-sided colon cancer[J].ANZ Journal of Surgery,2014,81(10):870-872.
[11]Charan I,Kapoor A,Singhal MK,et al.High ligation of inferior mesenteric artery in left colonic and rectal cancers:Lymph node yield and survival benefit[J].Indian Journal of Surgery,2015,77(3):1103-1109.
[12]Zhang Yun,Gong Hangjun,Han Gang,et al.Clinical application of laparoscopic D3 lymph node dissection with superior rectal artery preservation in radical resection of descending colon and proximal sigmoid carcinoma[J].Journal of Laparoscopic Surgery,2017,22(3):180-184.[张云,龚航军,韩刚,等.腹腔镜保留直肠上动脉的D3淋巴结清扫术在降结肠、近段乙状结肠癌根治术中的临床应用[J].腹腔镜外科杂志,2017,22(3):180-184.]
[13]Elkased A,Elgammal A,Ammar M,et al.Apical lymph node dissection and low ligation of inferior mesenteric artery in the management of distal colorectal cancer[J].Original Crtucle,2016,35(3):298-304.