全直肠系膜切除术中保留LCA治疗中低位直肠癌的效果及并发症观察

doi:10.3969/j.issn.1009-976X.2025.06.005

摘要/Abstract

摘要： 目的探究腹腔镜全直肠系膜切除术（TME）术中是否保留左结肠动脉（LCA）对中低位直肠癌患者治疗效果及并发症的影响。方法选取本院2019年1月至2024年12月收治的中低位直肠癌且行TME术患者,根据LCA处理方式不同,将其分为保留组与非保留组,经倾向性评分法排除基线资料混杂因素影响后,最终保留组纳入58例,非保留组纳入53例,匹配后两组基线资料均衡可比。分析并比较两组手术指标、并发症情况、血流灌注时间、排尿功能、胃肠道功能指标和炎性因子水平,并随访统计两组预后。结果保留组术后初次肛门排气时间、并发症发生率与吻合后的血液灌流时间低于非保留组（P<0.05）,边缘动脉弓压力高于非保留组（P<0.05）;术后1个月,保留组国际前列腺症状量表（IPSS）评分低于非保留组（P<0.05）;术后3 d,保留组胃动素和胃泌素水平高于非保留组（P<0.05）,而保留组白细胞介素-1β（IL-1β）、IL-6和肿瘤坏死因子-α水平低于非保留组（P<0.05）;随访6个月,两组均未出现死亡病例,两组短期并发症发生率、局部复发率及转移率比较,差异无统计学意义（P>0.05）。结论中低位直肠癌患者腹腔镜TME术中保留LCA更利于术后恢复,围手术期并发症风险及术后排尿障碍发生率更低。

关键词: 全直肠系膜切除术, 左结肠动脉, 中低位直肠癌

Abstract: Objective To investigate the influence of presence or absence of preservation of left colonic artery （LCA） during laparoscopic total mesorectal excision （TME） on the therapeutic effect and complications in patients with middle and low rectal cancer. Methods Patients with middle and low rectal cancer who underwent TME in the hospital from January 2019 to December 2024 were selected. According to different LCA treatment methods, they were divided into preservation group and non-preservation group. After excluding the influence of baseline data confounding factors by propensity score matching method, 58 cases were finally obtained in preservation group and 53 cases in non-preservation group. The baseline data of the two groups after matching were balanced and comparable. The surgical indexes, complications, blood perfusion time, urination function, gastrointestinal function indexes and inflammatory factors were analyzed and compared between the two groups, and the prognosis of the two groups was followed up and counted. Results The first postoperative anal exhaust time, incidence rates of complications and blood perfusion time after anastomosis in preservation group were shorter or lower than those in non-preservation group （P<0.05）, while marginal arterial arch pressure was higher （P<0.05）. At 1 month after surgery, the International Prostate Symptom Scale （IPSS） score was lower in preservation group than those in non-preservation group （P<0.05）. At 3 days after surgery, the motilin and gastrin levels in preservation group were higher （P<0.05） while the levels of interleukin-1β （IL-1β）, IL-6 and tumor necrosis factor-α were lower than those in non-preservation group （P<0.05）. At 6-month follow-up, no deaths occurred in either group. There were no significant differences between groups in short-term complications, local recurrence rate and metastasis rate （P>0.05）. Conclusion Preservation of LCA during laparoscopic TME for patients with middle and low rectal cancer is conducive to postoperative recovery, with low risk of perioperative complications and low incidence rate of postoperative urination disorders.

Key words: total mesorectal excision, left colonic artery, middle and low rectal cancer

中图分类号:

R657.1

曾岳岳, 夏悦明, 杨晓峰, 吴淑桃, 吴锦城, 陈招武. 全直肠系膜切除术中保留LCA治疗中低位直肠癌的效果及并发症观察[J]. 岭南现代临床外科, 2025, 25(06): 375-381.

ZENG Yue-yue, XIA Yue-ming, YANG Xiao-feng, WU Shu-tao, WU Jin-cheng, CHEN Zhao-wu. Observation on effect and complications of LCA preservation during total mesorectal excision in the treatment of middle and low rectal cancer[J]. Lingnan Modern Clinics In Surgery, 2025, 25(06): 375-381.

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