【摘要】 目的探讨精准低位结扎并根部淋巴结清扫在腹腔镜直肠癌根治术中的应用效果,为临床治疗提供依据。方法选择2017年3月至2019年3月普宁华侨医院外二科收治的80例直肠癌患者,通过随机数表法将患者分为观察组和对照组,每组40例。两组患者均行腹腔镜直肠癌根治术,对照组术中使用高位结扎,不保留左结肠动脉,观察组术中使用精准低位结扎,保留左结肠动脉,并进行根部淋巴结清扫。比较两组患者的围术期情况、术后病理情况及并发症发生率。结果两组患者均顺利完成手术;两组患者的手术时间、术中出血量、肛门排气时间、腹腔引流量、腹腔引流管停留时间、尿管停留时间和住院时间比较差异均无统计学意义(P>0.05);两组患者术后病理肿瘤近端切缘、远端切缘、淋巴结清扫总数量、阳性淋巴结数量比较差异均无统计学意义(P>0.05);观察组和对照组患者的排尿功能障碍发生率分别为2.50%和5.00%,差异无统计学意义(P>0.05);观察组患者吻合口相关并发症总发生率和低位前切除综合征发生率分别为7.5%、10.0%,明显低于对照组的25.0%、27.5%,差异均有统计学意义(P<0.05)。结论腹腔镜直肠癌根治术中使用精准低位结扎并根部淋巴结清扫和传统高位结扎相比,手术效果相似,但精准低位结扎并根部淋巴结清扫可保留左结肠动脉,有助于减少术后相关并发症,安全性更高。更多还原

【Abstract】 Objective To study the application effect of precise low ligation and root lymph node dissection in laparoscopic radical resection of rectal cancer, to provide reference for clinical treatment. Methods Eighty patients of rectal cancer who received therapy from March 2017 to March 2019 in the Department of External Medicine, Puning Overseas Chinese Hospital were selected, which were randomly divided into observation group and control group, with 40 patients in each group. The two groups of patients were all performed laparoscopic radical resection of rectal cancer. The control group applied high ligation without left colonic artery preservation, while the observation group used precise low ligation. The left colon artery was preserved, and the root lymph node dissection. The perioperative conditions, postoperative pathological conditions and the incidence of complications were compared between the two groups. Results The operation was successfully completed in the two groups. The operation time, intraoperative bleeding volume, anal exhaust time,abdominal drainage volume, retention time of abdominal drainage tube, retention time of urinary tube, and hospitalization time in the two groups were compared, and the differences were not statistically significant(P>0.05). The postoperative pathological tumors proximal margin, distal margin, total number of lymph node dissection, and number of positive lymph nodes in the two groups were compared, and the difference were not statistically significant(P>0.05). The incidence of urinary dysfunction in the observation group and control group were 2.50% and 5.00%, respectively, and there were no significant difference between the two groups(P>0.05). The incidence of anastomotic complications and low anterior resection syndrome in the observation group were 7.5% and 10.0%, which were significantly lower than 25.0%and 27.5% in the control group(P<0.05). Conclusion The laparoscopic radical resection of rectal cancer using precise low ligation and root lymph node dissection compared with traditional high ligation, and the effect of operation is similar, but precise low ligation and root lymph node dissection can preserve the left colonic artery, help to reduce the complications related to the operation, and have higher safety.更多还原