标题：全直肠系膜切除术中保留左结肠动脉对直肠癌患者临床疗效的影响

      作者：杨喜佳 1，徐建庆 1，韩鑫 2    1.西安高新医院普外科，陕西 西安 710061；2.汉中市人民医院普外科，陕西 汉中 723000

      卷次： 2021年32卷15期

      【摘要】 目的 研究全直肠系膜切除术(TME)中保留左结肠动脉治疗直肠癌对患者治疗效果的影响。方法 回顾性选取 2016年 7月至 2019年7月西安高新医院普外科收治的70例直肠癌患者，按在术中是否需要保留左结肠动脉分组，其中37例术中保留左结肠动脉者纳入观察组，33例不保留左结肠动脉者纳入对照组。比较两组患者围手术期指标、淋巴结清扫数目、血流灌注时间、吻合成功率，随访1年记录两组患者直肠癌复发率、病死率及并发症的发生率。结果 两组患者的手术时间、术中出血量、肠道功能恢复时间、淋巴结清扫数目、血流灌注时间、吻合成功率、直肠癌复发率和病死率比较差异均无统计学意义(P>0.05)；术后对照组患者发生吻合口瘘、肠梗阻各4例，发生率均为12.12%，观察组未发生吻合口瘘、肠梗阻，差异均有统计学意义(P<0.05)。结论 直肠癌患者在TME术中行低位结扎保留左结肠动脉可以改善吻合端血运，减少吻合口瘘和肠梗阻的发生。
      【关键词】 全直肠系膜切除术；直肠癌；左结肠动脉；疗效；并发症
      【中图分类号】 R735.3+7 【文献标识码】 A 【文章编号】 1003—6350（2021）15—1965—04

Effect of preserving the left colon artery in total mesorectal excision on the clinical efficacy of rectal cancerpatients.
YANG Xi-jia 1, XU Jian-qing 1, HAN Xin 2. 1. Department of General Surgery, Xi'an Gaoxin Hospital, Xi'an710061, Shaanxi, CHINA; 2. Department of General Surgery, Hanzhong People's Hospital, Hanzhong 723000, Shaanxi, CHINA
【Abstract】 Objective To study the effect of preserving the left colon artery in total mesorectal excision (TME)on the clinical efficacy of rectal cancer patients. Methods A total of 70 patients with rectal cancer admitted to the De-partment of General Surgery, Xi'an Gaoxin Hospital from July 2016 to July 2019 were selected retrospectively. Accord-ing to whether it is necessary to preserve the left colon artery during the operation, they were divided into two groups.Thirty-seven patients with the left colon artery during the operation were included in the observation group, and 33 pa-tients without the left colon artery were included in the control group. The perioperative indicators, the number of lymphnode dissection, blood perfusion time, and anastomosis success rate were compared between the two groups of patients.During the follow-up of 1 year, the recurrence rate, fatality rate and complication rate of rectal cancer were recorded andcompared between the two groups. Results There were no statistically significant differences in the operation time, in-traoperative blood loss, intestinal function recovery time, lymph node dissection number, blood perfusion time, anasto-mosis success rate, rectal cancer recurrence rate, and fatality rate between the two groups (P>0.05). After operation, therewere 4 cases of anastomotic leakage and intestinal obstruction each in the control group, and the incidence rate was12.12%; while the observation group did not have anastomotic leakage or intestinal obstruction, and the difference was sta-tistically significant (P<0.05). Conclusion In patients with rectal cancer, low ligation and preservation of the left colonartery during TME can improve the blood supply at the anastomotic end and reduce the occurrence of anastomotic leakageand intestinal obstruction.
      【Key words】 Total mesorectal excision; Rectal cancer; Left colonic artery; Curative effect; Complications