| Objective:To explore the two treatment methods for the preservation of the left colon artery(LCA)during laparoscopic anterior resection of rectal cancer,compare the surgical efficacy of postoperative patients,and evaluate the clinical application value of low ligation preservation LCA for rectal cancer radical surgery.Method:Retrospectively analyze the clinical data of 80 patients undergoing laparoscopic rectal cancer(Dixon operation)from July 2016 to July 2018 in our hospital.According to whether the left colon artery(LCA)is preserved,it is divided into two groups:40 cases in the preserved LCA group(as a test group)and 40 cases in the.non-preserved LCA group(as a control group).,Short-term recovery after surgery,and recurrence and metastasis.Results:All 80 patients underwent laparoscopic Dixon operation without conversion to laparotomy and perioperative deaths.The analysis of perioperative relevant indicators of the two groups of patients is as follows:1.Comparison of general data:the retained group VS the non-reserved group are:gender,age,body mass index,protein level,CA-199,CEA,tumor distance from the anal verge,tumor long diameter,general tumor type comparison,(P>0.05),the difference was not statistically significant.2.Intraoperative and postoperative data:retained group VS unreserved group:no significant difference in operation time:(254.34±64.19)min vs(252.30±52.62)min;the intraoperative blood loss retention group increased slightly compared to the non-reserved group:(181.00±105.14)ml vs(167.50±76.19)ml,(p>0.05),the difference was not statistically significant;in order to reduce the wall tension of the anastomosis site and achieve tension-free anastomosis in the operation area,a total of 6 cases of the spleen area were free in the retention group The descending colon accounted for 15.0%,3 cases in the non-reserved group,7.5%,1 patient in the reserved group underwent prophylactic ileostomy due to weak anastomotic wall,accounting for 2.5%,and the blood supply in the non-retained group was poor due to the anastomotic site A total of 4 patients underwent preventive ileostomy,accounting for 10.0%;days of postoperative hospital stay:the retention group was shorter than the non-retention group,and there was a slight heterogeneity:(14.35±6.26)d vs(16.05±5.67)d;postoperative Incisional infection:2 cases in the retention group,accounting for 5.0%,and 3 cases in the non-reservation group,accounting for 7.5%;postoperative exhaustion:the retention group was shorter than the non-reservation group:(3.80±1.60)d vs(4.35±1.70)d;anastomotic fistula:1 case in the reserved group,taking into account the elderly patients and poor postoperative malnutrition recovery,accounting for 2.5%(1/40),2 cases in the non-retained group,I case is considered to be anastomotic The position is too low,another case considers the lack of blood perfusion;5 patients had poor control after operation,2 cases in the reserved group,3 cases in the non-reserved group,and recovered after functional exercise in the later period;postoperative urinary function The incidence of disorders:5.0%(2/40)in the reserved group and 2.5%(1/40)in the non-reserved group,which was considered to be related to pelvic plexus injury;a total of 3 patients had sexual dysfunction after surgery:1 patient in the reserved group accounted for 2.5%,2 cases in the non-reserved group accounted for 5.0%.Considering that intraoperative hemorrhage and excessive electrocoagulation were related to pelvic plexus nerve thermal injury,the differences in the above indicators were not statistically significant(p>0.05).3.Comparison of pathological data:In terms of total lymph node dissection,the retention group is less than the non-reserved group:(14.45±2.77)vs(16.00±3.12),(p<0.05),the difference is statistically significant;IMA root lymph node dissection:reserved The group and the non-reserved group are equivalent:(3.20±1.41)vs(3.18±1.90),(P>0.05);IMA root lymph node positive rate comparison:retained group VS non-reserved group:15.0%vs 17.5%,(P>0.05),and histological type comparison(P=0.807),the difference was not statistically significant.4.Comparison of follow-up:All patients were followed up regularly for 3-18 months,postoperative CT,tumor index,colonoscopy,etc.,tumor recurrence:1 case in the reserved group and 2 cases in the non-retained group,the recurrence rates were 2.5%and 5.0,respectively%,(P>0.05),the difference was not statistically significant,distant metastasis:2 cases in the reserved group were all liver metastases,the metastasis rate was 5.0%,3 cases in the non-reserved group,1 case of liver and lung metastases,2 cases of liver Transfer,the transfer rate was 7.5%(P>0.05),the difference was not statistically significant.Conclusion:The results of the study found that in laparoscopic rectal cancer surgery,the LCA-preserving group was better than the LCA-preserving group in achieving the same treatment effect,which could ensure a certain number of lymph node dissections that were of clinical significance,and did not increase the risk of postoperative urogenital dysfunction Therefore,the retention of LCA group may improve the perfusion of anastomotic blood flow and reduce the risk of anastomotic leakage,and it is worthy of further study. |
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