| 摘要: |
| ［摘要］ 目的 观察腹腔镜下结直肠癌经自然腔道取标本手术（NOSES）中保留左结肠动脉（LCA）的中远期临床疗效。方法 回顾性分析2016年7月至2021年12月于四川省肿瘤医院行NOSES的155例直肠、乙状结肠癌患者的临床资料，根据术中是否保留LCA将其分为保留LCA组（80例）和不保留LCA组（75例），比较两组术后复发、转移及中远期生存情况。结果 保留LCA组随访4～65个月，不保留LCA组随访7～71个月。在随访期间发生局部复发或远处转移保留LCA组4例（5.1%），不保留LCA组7例（9.5%）。两组无病生存期(DFS)比较差异无统计学意义（P>0.05）。进一步以TNM分期进行分层分析，两组Ⅰ、Ⅱ、Ⅲ期患者的DFS比较差异亦无统计学意义（P>0.05）。保留LCA组死亡2例（2.5%），不保留LCA组死亡2例（2.7%），两组总生存期（OS）比较差异无统计学意义（P>0.05）。以TNM分期进行分层分析，两组Ⅰ、Ⅱ、Ⅲ期患者的OS比较差异均无统计学意义（P>0.05）。结论 腹腔镜结直肠癌NOSES中严格遵守肿瘤外科手术原则，在保留LCA的同时彻底清扫肠系膜下动脉根部的淋巴结不会影响结直肠癌患者的中远期治疗效果。 |
| 关键词: 腹腔镜 结直肠癌 经自然腔道取标本手术 临床疗效 |
| DOI：10.3969/j.issn.1674-3806.2023.06.11 |
| 分类号:R 735.3 |
| 基金项目:四川省科技厅创新团队资助课题（编号：2017TD0029） |
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| Observation on the medium to long-term efficacy of preserving the left colic artery during laparoscopic NOSES for colorectal cancer |
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FU Chuan-chuan, ZHAO Bin, YI Bo, et al.
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School of Medicine, University of Electronic Science and Technology of China, Sichuan 610054, China
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| Abstract: |
| ［Abstract］ Objective To observe the medium to long-term clinical efficacy of preserving the left colic artery(LCA) during laparoscopic natural orifice specimen extraction surgery(NOSES) for colorectal cancer. Methods The clinical data of 155 patients with rectal cancer or sigmoid colon cancer who underwent laparoscopic NOSES in Sichuan Cancer Hospital from July 2016 to December 2021 were retrospectively analyzed. According to whether the LCA was retained or not, the patients were divided into the retained LCA group(80 cases) and the non-retained LCA group(75 cases). The postoperative recurrence, metastasis, and medium to long-term survival were compared between the two groups. Results The retained LCA group was followed up for 4-65 months, and the non-retained LCA group was followed up for 7-71 months. During the follow-up periods, there were 4 cases(5.1%) of local recurrence or distant metastasis in the retained LCA group and 7 cases(9.5%) of local recurrence or distant metastasis in the non-retained LCA group. There was no significant difference in disease-free survival(DFS) between the two groups(P>0.05). Further stratified analysis was conducted using TNM staging, and there was no statistically significant difference in DFS between the two groups of stage Ⅰ, Ⅱ and Ⅲ patients(P>0.05). There were 2 deaths(2.5%) in the retained LCA group and 2 deaths(2.7%) in the non-retained LCA group. There was no significant difference in overall survival(OS) between the two groups(P>0.05). The results of the further stratified analysis using TNM staging showed that there was no statistically significant difference in OS between the two groups of stage Ⅰ, Ⅱ and Ⅲ patients(P>0.05). Conclusion Retaining the LCA while completely removing the root lymph nodes of the inferior mesenteric artery does not affect the patients′ medium to long-term oncologic outcomes, as long as the surgical oncologic principles are strictly followed during the laparoscopic NOSES for colorectal cancer. |
| Key words: Laparoscopy Colorectal cancer Natural orifice specimen extraction surgery(NOSES) Clinical efficacy |
