| Objectives:To investigate the effect of left colon artery preservation combined with the lymph node dissection of the inferior mesenteric artery and the short-term oncology effect,postoperative anastomotic leakage and postoperative intestinal function recovery in laparoscopic rectal anterior resection.This provides a reference for the selection of the treatment of the inferior mesenteric artery in total mesorectal excision.Materials and methods:From March 2016 to March 2018,the 199 patients who underwent laparoscopic rectal cancer low anterior resection at the Department of Gastrointestinal Surgery,Subei People's Hospital affiliated to Yangzhou University were enrolled in this study.All patients5 clinical data was analyzed retrospectively.According to different surgical methods,patients were divided into two groups:95 patients with preserving left colon artery(low ligation of the inferior mesenteric artery)and 104 patients without preserving left colon artery(high ligation of the inferior mesenteric artery).Patients of both two groups were performed with mechanical preparation routinely before surgery,and all operations were performed under general anesthesia with endotracheal intubation.The patients were placed with the Lloyd-Davies position,and elastic socks and pneumatic cuffs were used during surgery to prevent deep vein thrombosis.The entire procedure was performed by the same group of surgeons.General data of patients was collected,including:age,gender,BMI,ASA score,neoadjuvant chemotherapy history,tumor location,tumor diameter,postoperative pathological TNM staging,etc.;And the patients,operation time,intraoperative blood loss,the time of bowel opening,time of first flatus passage and postoperative hospitalized days were recorded;postoperative complications were also recorded.Statistical analysis was performed using SPSS 24.0 software.Continuous variables are presented as mean(s.d.)values.Categorical variables were compared by using chi-squared test and Fisher's test.Student's t-test was used to compare continuous variables.P<0.050 was considered statistically signifcant.All analyses were two-sided.Results:1.There were 55 male patients and 40 female patients in the group with preserving LCA.The mean age of the patients were 62.83±10.81 years old and the BMI were 23.75±3.67 kg/m2.104 patients were enrolled in the group without preserving LCA,including 65 male patients and 39 female patients.And the mean age of patients were 62.26±10.93 years old and BMI 23.80±3.08 kg/m2.No significant difference was observed in gender,age,BMI,tumor characteristics,pathological differentiation between the two groups(P>0.05)2.The operation time of the patients in the group with preserving LCA were 137.35±28.72 minutes,the intraoperative blood loss were 48.53±39.89ml,the total lymph node dissection and IMA root lymph node dissection were 16.05±3.33 and 4.04±1.52,respectively.The mean operation time of the group without preserving LCA were 129.96±29.56 minutes,intraoperative blood loss were 42.31±29.89ml,the total lymph node dissection and IMA root lymph node dissection were 15.47±3.66 and 4.13±1.60,respectively.There were no significant differences in the operation time,the amount of bleeding,and the number of lymph node dissections between the two groups(P>0.05).However,the differences between the two groups in the time of bowel opening(2.17±0.82vs.2.88±1.29 days),time of first flatus passage(2.73±1.10vs.3.66±1.75days)and postoperative hospitalized days(10.66±4.06vs.12.56±6.45days)were statistically significant(P<0.05);3.There were 4 patients diagnosed with complications in the group with preserving LCA(1 case of anastomotic leakage,1 case of rectal vaginal fistula,1 case of urinary dysfunction,1 case of cerebral infarction),the percentage of complications was 4.21%.And 19 cases of the group without preserving LCA were diagnosed with complications.There were 7 cases of anastomotic leakage,5 cases of anastomotic stenosis,2 cases of wound infection,3 cases of urinary dysfunction and 2 cases of intestinal obstruction.The percentage of complications was 18.27%.The total complications of the two groups were significantly different between the two groups(P<(X05).4.1 case of local recurrence and 3 cases in the distant metastasis in the group with preserving LCA,including 2 cases of liver metastasis and 1 case of peritoneal metastasis.There were 2 cases of local recurrence and 2 cases in the distant metastasisin the group without preserving LCA,including 1 case of liver metastasis and 1 case of lung metastasis.There was no significant difference in local recurrence and distant metastasis between the two groups(all P>0.05).Conclusion:(1)This study confirmed the incidence of anastomotic leakage in the group with preserving left colon artery was lower,although there was no significant statistically difference.(2)This study confirmed that the left colonic artery was preserved,which did not affect the dissection of the IMA root lymph nodes.Preserving the left colon artery achieved the same short-term oncology outcomes of the group without retaining the left colon artery.(3)Preserving the left colon artery promoted the recovery of digestive tract function and reduced the incidence of anastomotic stenosis.Although no significant difference was observed,and it was considered to be related to the small sample size. |
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