摘要
目的分析保留与不保留左结肠动脉(LCA)腹腔镜直肠癌根治术对直肠癌患者并发症发生率及预后的影响。方法回顾性收集100例直肠癌患者的临床资料,按照手术方法不同分为保留组(68例,行保留LCA腹腔镜直肠癌根治术)、不保留组(32例,行不保留LCA腹腔镜直肠癌根治术)。比较两组手术指标(淋巴结清扫数量、住院时间、术中出血量、手术时间、排气时间)、胃肠道功能(缩胆囊素、胃肠道生活质量指数、胃泌素)、肛肠功能(直肠最大容量、肛管静息压、Wexner便秘评分)、术后6个月并发症发生率以及术后2年复发率、转移率、生存率。结果与不保留组的(15.39±0.96)d、(29.60±1.42)h、(101.21±9.08)ml相比,保留组住院时间(13.72±1.04)d、排气时间(20.78±1.35)h更短,术中出血量(92.53±8.62)ml更少,差异具有统计学意义(P<0.05);两组淋巴结清扫数量、手术时间比较,差异无统计学意义(P>0.05)。术后7 d,与不保留组的(131.94±19.26)ng/L、(133.45±9.47)pg/ml、(76.32±5.07)分相比,保留组缩胆囊素(159.17±18.43)ng/L、胃泌素(145.18±8.56)pg/ml和胃肠道生活质量指数(89.15±4.88)分均更高,差异具有统计学意义(P<0.05)。术后7 d,与不保留组的(97.36±4.02)ml、(39.75±1.82)mm Hg(1 mm Hg=0.133 kPa)、(5.93±0.34)分相比,保留组直肠最大容量(108.51±3.75)ml、肛管静息压(42.86±1.35)mm Hg较高,Wexner便秘评分(4.08±0.21)分较低,差异具有统计学意义(P<0.05)。术后6个月,保留组并发症发生率较不保留组低,差异有统计学意义(1.47%vs.15.63%,P<0.05)。术后随访2年,保留组与不保留组复发率、转移率和生存率比较,差异无统计学意义(4.41%vs.15.63%、2.94%vs.12.50%,91.18%vs.81.25%,P>0.05)。结论保留与不保留LCA腹腔镜直肠癌根治术对直肠癌患者远期预后情况相当,但保留LCA腹腔镜直肠癌根治术在术后能更早的促进患者胃肠道功能恢复,且在肛肠功能改善方面更具优势,且并发症更少。
Objective To analyze the impact of preserving vs.non-preserving the left colonic artery(LCA)on postoperative complications and prognosis in patients undergoing laparoscopic radical resection of rectal cancer.Methods The clinical data of 100 patients with rectal cancer were retrospectively collected.Patients were categorized into two groups based on surgical approaches:the preservation group(68 cases,undergoing laparoscopic radical resection with preservation of the LCA)and the non-preservation group(32 cases,undergoing laparoscopic radical resection without preservation of the LCA).The following parameters were compared between groups:surgical indicators(number of lymph nodes resection,length of hospital stay,intraoperative blood loss,duration of surgery,anal exhaust time),gastrointestinal function(cholecystokinin,gastrointestinal quality of life index,gastrin),anorectal function(maximum rectal capacity,anal canal resting pressure,Wexner constipation score),6-month postoperative complication rates,and 2-year postoperative recurrence,metastasis,and survival rates.Results Compared with the non-preservation group[(15.39±0.96)d,(29.60±1.42)h,(101.21±9.08)ml],the length of hospital stay(13.72±1.04)d,anal exhaust time(20.78±1.35)h and the intraoperative blood loss(92.53±8.62)ml were shorter in the conservation group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the number of lymph node dissection and the duration of surgery between the two groups(P>0.05).On postoperative day 7,the preservation group had higher levels of cholecystokinin(159.17±18.43)ng/L,gastrin(145.18±8.56)pg/ml and gastrointestinal quality of life index(89.15±4.88)points compared with the non-preservation group[(131.94±19.26)ng/L,(133.45±9.47)pg/ml,and(76.32±5.07)points],and theses differences were statistically significant(P<0.05).On postoperative day 7,the preservation group exhibited significantly higher maximum rectal capacity(108.51±3.75)ml and anal canal resting pressure(42.86±1.35)mm Hg(1 mm Hg=0.133 kPa),and lower Wexner constipation scores(4.08±0.21)points compared with the non-preservation group[(97.36±4.02)ml,(39.75±1.82)mm Hg,and(5.93±0.34)points],and these differences were statistically significant(P<0.05).At 6 months postoperatively,the incidence of complications in the preservation group was significantly lower than in the non-preservation group(1.47%vs.15.63%,P<0.05).At 2-year postoperative follow-up,comparisons of recurrence rate,metastasis rate,and survival rate between the preservation and non-preservation groups showed no statistically significant differences(4.41%vs.15.63%,2.94%vs.12.50%,91.18%vs.81.25%;P>0.05).Conclusion Preserving versus non-preserving the LCA during laparoscopic radical resection for rectal cancer yields comparable long-term outcomes for patients.However,the LCA-preserving laparoscopic radical resection of rectal cancer can promote earlier postoperative recovery of gastrointestinal function,offers superior improvement in anorectal function,and results in fewer complications.
作者
李杨
张丽颖
LI Yang;ZHANG Li-ying(Rongcheng People's Hospital,Weihai 264300,China)
出处
《中国实用医药》
2026年第7期23-27,共5页
China Practical Medicine
关键词
直肠癌
腹腔镜直肠癌根治术
左结肠动脉
胃泌素
肛管静息压
缩胆囊素
直肠最大容量
Rectal cancer
Laparoscopic radical resection of rectal cancer
Left colonic artery
Gastrin
Anal canal resting pressure
Cholecystokinin
Maximum rectal capacity
