摘要
目的:观察全直肠系膜切除术(TME)中保留左结肠动脉(LCA)在直肠癌患者中的应用效果。方法:回顾性分析2019—2022年该院收治的106例直肠癌患者的临床资料,根据术中是否保留LCA将其分为对照组(n=56)和研究组(n=50),两组均行TME治疗。对照组术中不保留LCA,研究组术中保留LCA,比较两组围术期指标(手术时间、术中出血量、淋巴结清扫数目、首次排气时间、首次进食时间、术后住院时间)水平,手术前后T细胞亚群指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、肛肠功能指标[肛肠静息压(ARP)、直肠肛管抑制反射阈值(AIRT)、高压区长度(HPZ)]水平,以及并发症发生率。结果:两组手术时间、术中出血量、淋巴结清扫数目比较,差异均无统计学意义(P>0.05);研究组首次排气时间、首次进食时间、术后住院时间均短于对照组,差异有统计学意义(P<0.05);术后3、5 d,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均低于术前,但研究组高于对照组,差异有统计学意义(P<0.05);术后1、2周,两组ARP、HPZ水平均低于术前,但研究组高于对照组,两组AIRT水平均高于术前,但研究组低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为6.00%(3/50),低于对照组的25.00%(14/56),差异有统计学意义(P<0.05)。结论:TME术中保留LCA治疗直肠癌患者,可促进患者康复,改善免疫功能和肛肠功能,降低并发症发生率,效果优于TME术中不保留LCA治疗。
Objective:To observe application effects of left colonic artery preservation(LCA)in total mesorectal excision(TME)in patients with rectal cancer.Methods:The clinical data of 106 patients with rectal cancer admitted to the hospital from 2019 to 2022 were retrospectively analyzed.According to whether LCA was preserved during the surgery,they were divided into control group(n=56)and study group(n=50).Both groups were treated with TME.LCA was not preserved in the control group,while LCA was preserved in the study group.The levels of perioperative indexes(operation time,intraoperative blood loss,number of lymph node dissected,first exhaust time,first feeding time,postoperative hospitalization time),the levels of T cell subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))and anorectal function indexes[anorectal resting pressure(ARP),anorectal inhibitory reflex threshold(AIRT),high pressure zone length(HPZ)]before and after the surgery,and the incidence of complications were compared between the two groups.Results:There were no significant differences in the operation time,intraoperative blood loss and number of lymph node dissected between the two groups(P>0.05).The first exhaust time,the first feeding time and the postoperative hospitalization time of the study group were shorter than those of the control group,and the differences were statistically significant(P<0.05).3 and 5 days after the surgery,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the two groups were lower than those before the surgery,but those in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).1 and 2 weeks after the surgery,the levels of ARP and HPZ in the two groups were lower than those before the surgery,but those in the study group were higher than those in the control group;the AIRT levels of the two groups were higher than those before the surgery,but that in the study group was lower than that in the control group;and the differences were statistically significant(P<0.05).Further,the incidence of complications in the study group was 6.00%(3/50),which was lower than 25.00%(14/56)in the control group,and the difference was statistically significant(P<0.05).Conclusions:The preservation of LCA in TME for the patients with rectal cancer can promote the rehabilitation of these patients,improve the immune function and the anorectal function,and reduce the incidence of complications.Moreover,it is superior to TME without LCA preservation.
作者
朱乐意
刘君昭
孙占勇
ZHU Leyi;LIU Junzhao;SUN Zhanyong(Department of General Surgery of Zhengzhou No.1 People’s Hospital,Zhengzhou 450000 Henan,China)
出处
《中国民康医学》
2024年第20期42-44,48,共4页
Medical Journal of Chinese People’s Health
关键词
直肠癌
全直肠系膜切除术
左结肠动脉
T细胞亚群
肛肠功能
并发症
Rectal cancer
Total mesorectal excision
Left colonic artery
T cell subset
Anorectal function
Complication
