Benefit analysis of preservation of left colonic artery in laparoscopic radical resection of rectal cancer in elderly patients
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摘要: 目的 探讨腹腔镜直肠癌根治术中保留左结肠动脉(LCA)对老年直肠癌患者的获益分析。 方法 回顾性分析204例接受腹腔镜直肠癌根治术的老年患者的病例资料,将保留LCA者纳入保留组(98例),未保留LCA者纳入不保留组(106例),比较2组患者的手术相关情况。 结果 保留组手术时间为(121.41±14.02)min, 显著长于不保留组的(109.74±12.92)min(P<0.01); 保留组结肠脾曲松解率显著高于不保留组(P<0.05); 保留组均未行预防性回肠造瘘,不保留组有6例行预防性回肠造瘘,差异有统计学意义(P<0.05)。2组在淋巴结清扫总数与第253组淋巴结清扫数量、术中出血量、术后排气时间以及近端结肠缺血、吻合口出血、吻合口漏发生情况方面比较,差异均无统计学意义(P>0.05)。 结论 老年直肠癌患者腹腔镜直肠癌根治术中保留LCA, 可减少预防性回肠造瘘,并可达到淋巴结清扫的要求,技术上安全可行。Abstract: Objective To evaluate the clinical significance of preservation of the left colonic artery(LCA)in laparoscopic radical resection of rectal cancer in elderly patients. Methods Clinical data of 204 rectal cancer patients undergoing laparoscopic radical resection was retrospectively analyzed, 98 cases with preservation of LCA were selected as preservation group and 106 cases without preservation of LCA were included in non-preservation group. Operation-related conditions were compared between the two groups. Results Operation time was significantly longer in the preservation group than that in the non-preservation group ［(121.41±14.02)min vs.(109.74±12.92)min, P<0.01］. The cololysis of splenic flexure in the preservation group was significantly higher than that in the non-preservation group(P<0.05). The preservation group underwent no preventive terminal ileum stoma, and 6 cases in the non-preservation group received preventive terminal ileum stoma, a significant difference was found in two groups(P<0.05). No significant differences in terms of total number of lymph node dissection and the number of lymph node(No.253)dissection, intraoperative blood loss, postoperative exhaust time, proximal colonic ischemia, anastomotic bleeding, anastomosis leakage were found between the two groups(P>0.05). Conclusion Preservation of the left colonic artery in laparoscopic radical resection of rectal cancer in elderly patients can reduce preventive terminal ileum stoma, conform to the requirement of radical clearance of lymph nodes, and it is safe and feasible in technology.
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