CAJ | 학술논문

目的探讨腹腔镜直肠癌前切除术中处理肠系膜下动脉(IMA)时保留左结肠动脉(LCA)的可行性与应用价值.方法回顾性分析2010年4月至2013年10月72例腹腔镜直肠癌前切除术患者的临床资料,患者按随机数字表法分为两组,其中保留LCA 32例(观察组),不保留LCA40例(对照组),比较两组术中出血量、手术时间、术后排气时间、末端回肠造口情况、IMA根部淋巴结清扫数目、IMA根部淋巴结转移及预后情况.结果观察组和对照组术中出血量、手术时间、术后排气时间、IMA根部淋巴结清扫数目、IMA根部淋巴结转移率比较差异均无统计学意义(P＞0.05).观察组均无需游离结肠脾区及做末端回肠造口;而对照组3例因近端肠管血运障碍需游离结肠脾曲(P=0.046),4例吻合后加做末端回肠造口(P=0.042).观察组术后无吻合口漏,而对照组术后有2例吻合口漏(P=0.090).两组术后随访6～48个月,局部复发率及肝转移率比较差异无统计学意义(P＞0.05).结论腹腔镜直肠癌前切除术中处理IMA时保留LCA可以有效保障近端肠管血运.
목적 탐토복강경직장암전절제술중처리장계막하동맥(IMA)시보류좌결장동맥(LCA)적가행성여응용개치.방법 회고성분석2010년4월지2013년10월72례복강경직장암전절제술환자적림상자료,환자안수궤수자표법분위량조,기중보류LCA 32례(관찰조),불보류LCA40례(대조조),비교량조술중출혈량、수술시간、술후배기시간、말단회장조구정황、IMA근부림파결청소수목、IMA근부림파결전이급예후정황.결과 관찰조화대조조술중출혈량、수술시간、술후배기시간、IMA근부림파결청소수목、IMA근부림파결전이솔비교차이균무통계학의의(P＞0.05).관찰조균무수유리결장비구급주말단회장조구;이대조조3례인근단장관혈운장애수유리결장비곡(P=0.046),4례문합후가주말단회장조구(P=0.042).관찰조술후무문합구루,이대조조술후유2례문합구루(P=0.090).량조술후수방6～48개월,국부복발솔급간전이솔비교차이무통계학의의(P＞0.05).결론 복강경직장암전절제술중처리IMA시보류LCA가이유효보장근단장관혈운.
Objective To explore the feasibility and value of preservation of left colonic artery (LCA) in dealing with inferior mesenteric artery (IMA) in laparoscopic anterior resection of rectal carcinoma.Methods The clinical data of 72 cases of laparoscopic anterior resection of rectal carcinoma from April 2010 to October 2013 were retrospectively analyzed including 32 cases with preservation of LCA (observation group) and 40 cases without preservation of LCA (control group).The blood loss,operative time,postoperative exhaust time,terminal ileum stoma,the number of lymph nodes removed around the root of IMA,the rate of lymph node metastasis around the root of IMA and prognosis were compared between two groups.Results There was no significant difference in the blood loss,operative time,postoperative exhaust time,terminal ileum stoma,the number of lymph nodes removed around the root of IMA,the rate of lymph node metastasis around the root of IMA between two groups (P ＞ 0.05).No case in observation group needed to free the splenic flexure of colon and to make the terminal ileum stoma,while 3 cases in control group needed to free splenic flexure of colon because of blood supply disorder in the proximal intestine (P =0.046),and 4 cases underwent terminal ileum stoma following anastomosis (P =0.042).No anastomotic leakage occurred in observation group,while 2 cases of anastomotic leakage occurred in control group(P =0.090).After followed up for 6-48 months,no significant difference was found in local recurrence and liver metastasis in two groups (P ＞ 0.05).Conclusion Laparoscopic anterior resection of rectal carcinoma with preservation of LCA in dealing with IMA can effectively retain the blood supply of proximal intestine.