目的

评估腹腔镜直肠癌全系膜切除术中保留左结肠动脉（升支）的疗效及对手术应激反应、肛门功能的影响。

方法

纳入2021年8月至2023年8月100例行腹腔镜直肠癌全系膜切除术的患者病例，依据左结肠动脉（LCA）保留情况分为A组（不保留LCA，n=50例）和B组（保留LCA，n=50例），评价组间手术一般情况、胃肠激素、应激反应、肛门功能、并发症。统计学分析先对不同组间年龄、性别等进行方差齐性检验，对并发症行χ²检验，对手术一般情况、胃肠激素、应激反应、肛门功能行t检验。P<0.05为差异有统计学意义。

结果

B组淋巴结清扫数目更多，手术时间更长，肠道功能恢复时间、肛门排气时间更短（P<0.05）；术后，B组胃肠激素［胃泌素（GAS）、胃动素（MTL）］、肛门功能更高［最大耐受容量（MTV）、高压区长度（HPZ）、肛管最大收缩压（MSP）］，应激反应更低［醛固酮（ALD）、血管紧张素II（Ang II）、去甲肾上腺素（NE）］，P<0.05；较之A组（16.0%）相比B组并发症发生率（4.0%）更低（P<0.05）。

结论

在腹腔镜直肠癌全系膜切除术中保留LCA，容易延长手术时间，但是不影响淋巴结清扫，并且可以促进胃肠功能恢复，减少并发症，减轻应激反应及对肛门功能的影响，有临床借鉴意义。

Objective

To evaluate the efficacy of preserving the ascending branch of the left colic artery (LCA) during laparoscopic total mesorectal excision for rectal cancer and its effects on surgical stress response and anal function.

Methods

The cases of 100 patients who underwent laparoscopic total mesorectal excision for rectal cancer from August 2021 to August 2023 were included. According to the preservation status of the left colic artery (LCA), they were divided into group A (without preserving LCA, n=50 cases) and group B (preserving LCA, n=50 cases). The general surgical conditions, gastrointestinal hormones, stress response,anal function, and complications were evaluated between the groups. In the statistical analysis, the homogeneity of variance test was first carried out for age, gender, etc. between different groups, the chi-square test was performed for complications, and the t test was conducted for general surgical conditions, gastrointestinal hormones, stress response, and anal function. P<0.05 was considered as a statistically significant difference.

Results

The number of dissected lymph nodes in group B was larger, the operation time was longer, and the recovery time of intestinal function and the time to anal exhaust were shorter (P<0.05). After surgery, the levels of gastrointestinal hormones ［gastrin (GAS), motilin (MTL)］and anal function ［maximum tolerable volume (MTV),length of the high-pressure zone (HPZ), maximum systolic pressure of the anal canal (MSP)］in group B were higher, while the stress response ［aldosterone (ALD), angiotensin II (Ang II), norepinephrine (NE)］was lower(P<0.05). The incidence of complications in group B (4.0%) was lower than that in group A (16.0%) (P<0.05).

Conclusion

Preserving the LCA during laparoscopic total mesorectal excision for rectal cancer may prolong the operation time, but it does not affect the lymph node dissection. Moreover, it can promote the recovery of gastrointestinal function, reduce complications, alleviate the stress response, and reduce the impact on anal function, which has clinical reference significance.