关键词: 腹腔镜直肠癌前切除术, 直肠癌, 左结肠动脉, 吻合口漏, 近期疗效

Abstract: Objective：To explore the influence of preserving left colic artery（LCA）during during laparoscopic anterior resection for rectal cancer on anastomotic leakage and recent efficacy.Methods：The clinical data of 138 patients undergoing laparoscopic anterior resection for rectal cancer r were retrospectively analyzed.The patients were divided into two groups according to the operation method：62 patients with preservation of LCA with low ligation of the inferior mesenteric artery（IMA）as the observation group，76 patients without preservation of LCA and high ligation of the IMA as control group.The general data，postoperative pathological findings，perioperative indicators，and postoperative complications were compared between the two groups.Serum antiangiogenic chemokine CXCL9，soluble E selectin（sEselectin），carcinoembryonic antigen（CEA）and carbohydrate antigen 199（CA199）were measured before and 6，12 months after surgery.All were followed up for 3 years to report recurrence and metastasis.Results：There was no significant differences in general data and postoperative pathological findings（3rd station lymph node metastasis rate，pathological type，TNM staging）between the two groups（P>0.05）.There was no significant difference in the number of lymph node diss ections [（12.44±1.92）vs（12.61±2.23）]，operation time [（130.59±17.48）h vs（128.06±16.11）h]，intraoperative blood loss [（74.85±14.69）ml vs（77.43±16.86）ml] between the observation group and the control group（P>0.05），while the difference of postoperative exhaust time [（72.53±1.79）h vs（76.11±2.82）h] and the postoperative hospital stay[（5.66±0.45）d vs（6.22±0.53）d] between the two groups was significant（P<0.05）.There was no significant differences in incision infection（0 vs 3.57%），intestinal obstruction（2.27% vs 3.57%），urinary retention（4.55% vs 7.14%），sexual dysfunction（2.27% vs 3.57%），poor stool control（2.27% vs 8.93%）between the observation group and the control group（P>0.05），while the difference of anastomotic leakage（0 vs 10.71%）between the two groups was significant（P<0.05）.At 6 and 12 months after operation，the serum levels of CXCL9，sEselectin，CEA and CA199 were significantly lower than before operation（P<0.05），but there were no significant differences between the two groups（P>0.05）.At 1 and 3 years after surgery，the recurrence and metastasis rates in the observation group were 4.55% and 20.45% respectively，which were not statistically different with 3.57% and 19.64% in the control group（P>0.05）.The overall survival rate in the observation group was 97.73% and 84.09%，which were not statistically different with 100.00% and 85.71% in the control group（P>0.05）.Conclusion：Preserving LCA during laparoscopic anterior resection of rectal cancer is beneficial to protect blood flow in the proximal anastomosis and reduce the incidence of postoperative anastomotic leakage，without increasing the difficulty of surgery and the risk of postoperative recurrence and metastasis.

Key words: laparoscopic anterior resection for rectal cancer, rectal cancer, left colonic artery, anastomotic fistula, shortterm efficacy