保留左结肠动脉腹腔镜直肠癌低位前切除术患者5年生存率研究

摘要

Objective To investigate the results of 5-year follow up of preserving left colic artery (LCA) after laparoscopic low anterior resection for rectal cancer. Methods 90 patients underwent laparoscopic low anterior resection of rectal cancer were randomly assigned into two groups, with 45 cases in each group. The treatment group retained LCA, while the control group did not. The operation and postoperative complications of the two groups were recorded. The survival rate of 5-year follow-up was compared between the two groups. Results There was no significant difference in operation duration, intraoperative blood loss, the total number of lymph node dissected and the number of positive lymph node number between the two groups (P ＞ 0.05). The first exhaust time was significantly shorter in the treatment group than that in the control group (P ＜ 0.05). There was no significant difference between the two groups in rate of postoperative complication (P ＞ 0.05). Two cases in the treatment were lost during the follow-up. Twenty-six cases had disease progression in 5 years, and 19 cases died. The median survival times was (47.70±2.45) months. Three cases in the control group were lost during follow-up. Twenty-three cases had disease progression in 5 years. Seventeen cases died. The median survival times was (49.40±2.32) months. There was no significant difference in overall survival rate and progression free survival rate between the two groups after 5 years (Log rank χ2 = 0.166 and 0.376, respectively; P = 0.683 and 0.540, respectively). Conclusion The laparoscopic low anterior resection with preserving LCA for rectal cancer is helpful to reduce postoperative complications and promote early recovery of patients. It has comparable long-term prognosis.%目的 观察保留左结肠动脉(LCA)的腹腔镜直肠癌低位前切除术患者术后5年生存情况.方法 纳入90例接受腹腔镜直肠癌低位前切除术的患者作为研究对象,随机分为观察组(保留LCA),对照组(未保留LCA),每组各45例.记录两组手术基本情况和术后并发症情况,术后随访5年,比较两组术后生存情况.结果 两组患者手术时间、术中出血量、淋巴结清扫数及淋巴结阳性数差异均无统计学意义(均P ＞ 0.05),观察组术后首次排气时间短于对照组(P ＜ 0.05).术后并发症发生率组间差异无统计学意义(P ＞ 0.05).观察组术后随访失访2例,5年内疾病进展26例,其中死亡19例,中位生存时间(47.70±2.45)月.对照组失访3例,5年内疾病进展23例,其中死亡17例,中位生存时间(49.40±2.32)月.两组术后5年总生存率和无进展生存率差异均无统计学意义(Log rank χ2= 0.166、0.376,P = 0.683、0.540).结论 腹腔镜直肠癌低位前切除术中保留LCA有助于减少术后并发症,促进患者早期恢复,且远期预后与未保留LCA患者相当.