The Clinical Research Of Laparoscopic Anterior Resection Of Rectal Carcinoma With Preservation Of The Left Colonic Artery Under D3 Therapy

Objective: The influence of Laparoscopic Anterior Resection of Rectal Carcinoma(D3 radical cure)preserve the left colonic artery to the incidence of anal ischemic necrosis and stenosis after surgery,and the revaluation between the life quality after surgery with the proximal lymph node dissection.Methods: A total of 130 patients entered the research according to the admission criteria for rectal cancer operation medical records from January 2018 to November 2019.Test group: low ligation group,64 cases,D3 radical cure,the inferior mesenteric artery diverged from the left colonic artery and was transected;Control group: high ligation group,66 cases,D3 radical cure,the inferior mesenteric artery diverged about 1cm from the abdominal aorta.Record the complete original data of each group,analyze and compare the following aspects of two groups including the general data in the clinical data,the relevant indexes of operation,the index of postoperative recovery,the index of postoperative pathology and the postoperative follow-up visit assessment.Results: There was no significant difference in preoperative data and preoperative evaluation in this research.There was no significant difference between the two groups in the comparison of intraoperative bleeding volume,surgical incision length,intraoperative blood transfusion,and the number of drainage tubes.The duration of operation in the experimental group was 90-210 minutes,the median duration was 140 minutes,the duration of operation in the control group was 120-230 minutes,the median duration was 180 minutes,and P <0.001,there was a significant statistical difference.There are 2 anastomotic leak cases(3.1%)in test group,and 9 anastomotic leak cases(13.6%)in control group,P =0.031,there was a significant statistical difference.However,there was no significant difference in other complications.Postoperative exhaust time was 24-120 h,P =0.014,defecation time was 57h(24-120h),72h(24-144h),P =0.008,there was a statistical difference between the two groups.The feeding time was 91h(48-288h),96h(42-168h),P =0.723,and the catheter extraction time was 48h(24-147h)and 48h(24-16h),respectively 8h),P =0.382,anal canal extraction time was 120h(48-264h),120h(48-264h),P =0.813,after comparison,the results of the two groups were found there was no significant statistical difference.The postoperative hospitalization time of the test group was 9d(5-23d)and the control group was 11d(6-32d),and P =0.010,the results have significant difference.After analyzing the postoperative pathological report,it was found that there was no significant difference in maximum tumor diameter,histological type,gross type differentiation degree,total lymph node detection and cancer nodules,nerve buried tube infiltration and TNM stage.After 90 days of follow-up,the control group died of 1 case,the two groups of male IPSS score(mild level)were 12 cases and 7 cases,respectively,4 cases of each groups(moderate level),P=0.919.In IIEF-5 scores there are 15(41.7%)and 9(21.4%)mild level cases,7(11.1%)and 7(16.7%)moderate level cases,2 severe level cases in control group,P=0.890 there was no statistical difference.Urinary incontinence score reflect in the test group was 25 abnormal cases(40.8%),in the control group was 17 abnormal cases(25.8%),P =0.901,and there was no significant difference between the two groups.It was found that the defecation times after surgery reflect in the two groups were 3 times(1-6 times)and 5 times(2-8 times),P=0.061,the number of defecation times in the test group was significantly lower than that in the control group,without any significant statistical difference.Conclusion: preserving the left colon artery can reduce the incidence of anastomotic leakage,it also can effectively promote the recovery of gastrointestinal function after surgery,and shorten the LOS(length of stay)after surgery,but the left colon artery obviously increases the operation time,and the degree of lymph node dissection in the operation is lower than that in the unreserved group,retention of left colonic artery had no significant effect on postoperative urinary retention,erectile function and defecation.