Clinical Observation Of Left Colic Artery Preservation During The Laparoscopic Radical Resection For Rectal Cancer(Dixon Surgery)

Objective:To explore the clinic effect of left colic artery(LCA)preservation during the laparoscopic radical resection for rectal cancer(Dixon surgery).Methods:The clinical data of 126 cases of laparoscopic radical resection of rectal cancer(Dixon)from May 2016 to August 2018 in the gastrointestinal ward of the First Affiliated Hospital of SUDA was analyzed retrospectively.64 cases were divided into observation group(retained LCA)and 62 cases into control group(not retained LCA)based on whether left colon artery was preserved during operation.The total number of mesenteric lymph node dissection,the distance between anastomotic stoma and anal margin,operation time,intraoperative bleeding volume and free spleen area were compared between the two groups.Results were collected for the time of anal exhaust and hospitalization,incision infection,anastomotic hemorrhage,anastomotic leakage,urinary retention and pathological results.Observations were made for the 3-month defecation function and the differences among recurrence,metastasis and survival rate within 1 year after operation.Results:The operation was successful in both the observation group and the control group,and none of them was converted to open surgery.There were no significant differences in the time of operation,the total number of mesenteric lymph node dissection,the distance between the anastomosis and the anal margin,the amount of intraoperative blood loss,the time of exhaustion,and the length of hospital stay between the LCA-preserved group and the non-LCA-preserved group(P>0.05).In the incidence of postoperative complications,there were no significant differences in the complications of incision infection,anastomotic bleeding,and urinary retention(3.13%,3.13%,1.56%)compared with the control group(0.00%,0.00%,4.84%)(P>0.05).The observation group(0.00%,0.00%)was significantly lower than the control group(8.06%,6.45%)in the incidence of anastomotic leakage and free splenic flexion(P<0.05);There were no significant differences in the recurrence and metastasis rate between the observation group(6.25%,3.13%)and the control group(3.23%,3.23%)(P>0.05).There was no significant difference in the half-year survival rate between the observation group(98.44%)and the control group(96.77%)(P>0.05).In the 1-year survival rate,the observation group(96.87%)and the control group(93.55%)No significant difference(P>0.05).By comparing the clinical and pathological data of patients after operation,it was found that all the specimens were negative,and there was no significant difference in histological differentiation type and TNM stage between the two groups(P>0.05).There was no significant difference in the fecal function between the 3 months after surgery(P>0.05).Conclusion:The retention of LCA in laparoscopic rectal cancer(Dixon)can effectively ensure the blood supply to the descending colon and anastomosis,reduce the incidence of intraoperative free splenic sputum and postoperative anastomotic leakage,does not affect lymph node dissection,and does not increase the probability of tumor recurrence and transfer.This method is safe,feasible and effective.And it is worthy of clinical promotion.