Clinical Observation Of The Laparoscopic Radical Resection Of Rectal Carcinoma With Preservation Of The Left Colonic Artery

Objective: To investigate the feasibility and application of preservation of left colonic artery(LCA)during laparoscopic rectal cancer in the anterior resection of the lower mesenteric artery(IMA).Methods: Retrospective analysis of 74 patients with laparoscopic rectal cancer anterior resection(Dixon surgery)from March 1st,2016 to December 31 st,2017 in the Department of Gastrointestinal Surgery,Affiliated Yijishan Hospital of Wannan Medical College For the data,36 patients were enrolled in the LCA group(observation group)and 38 patients in the LCA group(control group).The observation group was cut off from the lower edge of the LCA bifurcation at 0.5 cm to 1.0 cm and the LCA was retained.The IMA was cut at a distance of 0.5 cm to 1.0 cm from the root of the IMA.The intraoperative blood loss,operation time,preventive ileostomy,free spleen curvature,postoperative venting time,anastomotic leakage and urination and sexual dysfunction were analyzed.Total lymph node dissection was analyzed.Number,number of lymph node dissection around IMA,length of tumor,and TNM stage(according to AJCC Seventh Edition)and the incidence of distant recurrence of local recurrence.Results: All 74 patients were successfully operated without conversion to open surgery.There was no statistically significant difference between the two groups(P>0.05).The operation time,intraoperative blood loss,tumor long diameter,total lymph node dissection and 253 lymph node dissection were 139.8±2.69,140.3±1.82,61.97±1.41,58.66±1.51,5.03±0.18,4.96±,respectively.0.15,19.17±0.55,19.42±0.47,3.61±0.17,3.60±0.15,there was no significant difference between the two groups(P>0.05).In the control group,2 patients had free spleen due to a large anastomotic tension.One of them had cyanosis in the intestine after intestinal reconstruction,which resulted in ileostomy.However,there was no case of free spleen and ileostomy in the observation group.There was no significant difference between the two groups(P>0.05).There were no anastomotic leakage in 36 patients in the observation group,and anastomotic leakage occurred in 6 of the 38 patients in the control group.The difference was statistically significant(P<0.05).The postoperative exhaust time of the observation group was 2.74±0.09,and the postoperative exhaust time of the control group was 3.03±0.07.The difference between the two groups was statistically significant(P<0.05).There was no significant difference in TNM staging between the two groups after urinary and sexual dysfunction and tumor.The median follow-up time of the two groups was 18 months.In the observation group,1 patients had local recurrence and 1 patients had liver metastasis.In the control group,1 patients had anastomotic recurrence,1 patients had liver metastasis,and 2 patients had lung metastasis.There were no significant differences in local recurrence and distant metastasis between the two groups(P>0.05).Conclusion: For patients with rectal cancer who have stage I,II,and III laparoscopic rectal cancer with low anterior resection,it is safe,feasible,and effective to maintain LCA.This procedure provides more adequate anastomosis.Blood supply,reduce the incidence of anastomotic leakage,and complete the same thorough lymph node dissection with high ligation,which has certain positive significance for the recovery of intestinal function.The short-term efficacy of this procedure is also satisfactory,without increasing tumor recurrence and distant metastasis,and has certain clinical promotion value.