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Abstract：
BACKGROUND: Laparoscopic low anterior resection (LLAR) has become a mainstream surgical method for the treatment of colorectal cancer, which has shown many advantages in the aspects of surgical trauma and postoperative rehabilitation. However, the effect of surgery on patients\' left coronary artery and its vascular reconstruction have not been deeply discussed. With the development of medical imaging technology, 3D vascular reconstruction has become an effective means to evaluate the curative effect of surgery.
OBJECTIVE: To investigate the clinical value of preoperative 3D vascular reconstruction in LLAR of rectal cancer with the left colic artery (LCA) preserved.
METHODS: A retrospective cohort study was performed to analyze the clinical data of 146 patients who underwent LLAR for rectal cancer with LCA preservation from January to December 2023 in our hospital. All patients underwent LLAR of rectal cancer with the LCA preserved, and the intraoperative and postoperative data were complete. The patients were divided into a reconstruction group (72 patients) and a nonreconstruction group (74 patients) according to whether 3D vascular reconstruction was performed before surgery. The clinical features, operation conditions, complications, pathological results and postoperative recovery of the two groups were collected and compared.
RESULTS: A total of 146 patients with rectal cancer were included in the study, including 72 patients in the reconstruction group and 74 patients in the nonreconstruction group. There were 47 males and 25 females in the reconstruction group, aged (59.75 ± 6.2) years, with a body mass index (BMI) (24.1 ± 2.2) kg/m2, and 51 males and 23 females in the nonreconstruction group, aged (58.77 ± 6.1) years, with a BMI (23.6 ± 2.7) kg/m2. There was no significant difference in the baseline data between the two groups (P > 0.05). In the submesenteric artery reconstruction group, 35 patients were type I, 25 patients were type II, 11 patients were type III, and 1 patient was type IV. There were 37 type I patients, 24 type II patients, 12 type III patients, and 1 type IV patient in the nonreconstruction group. There was no significant difference in arterial typing between the two groups (P > 0.05). The operation time of the reconstruction group was 162.2 ± 10.8 min, and that of the nonreconstruction group was 197.9 ± 19.1 min. Compared with that of the reconstruction group, the operation time of the two groups was shorter, and the difference was statistically significant (t = 13.840, P < 0.05). The amount of intraoperative blood loss was 30.4 ± 20.0 mL in the reconstruction group and 61.2 ± 26.4 mL in the nonreconstruction group. The amount of blood loss in the reconstruction group was less than that in the control group, and the difference was statistically significant (t = -7.930, P < 0.05). The rates of anastomotic leakage (1.4% vs 1.4%, P = 0.984), anastomotic hemorrhage (2.8% vs 4.1%, P = 0.672), and postoperative hospital stay (6.8 ± 0.7 d vs 7.0 ± 0.7 d, P = 0.141) were not significantly different between the two groups.
CONCLUSIONS: Preoperative 3D vascular reconstruction technology can shorten the operation time and reduce the amount of intraoperative blood loss. Preoperative 3D vascular reconstruction is recommended to provide an intraoperative reference for laparoscopic low anterior resection with LCA preservation.
OBJECTIVE: To investigate the clinical value of preoperative 3D vascular reconstruction in LLAR of rectal cancer with the left colic artery (LCA) preserved.
METHODS: A retrospective cohort study was performed to analyze the clinical data of 146 patients who underwent LLAR for rectal cancer with LCA preservation from January to December 2023 in our hospital. All patients underwent LLAR of rectal cancer with the LCA preserved, and the intraoperative and postoperative data were complete. The patients were divided into a reconstruction group (72 patients) and a nonreconstruction group (74 patients) according to whether 3D vascular reconstruction was performed before surgery. The clinical features, operation conditions, complications, pathological results and postoperative recovery of the two groups were collected and compared.
RESULTS: A total of 146 patients with rectal cancer were included in the study, including 72 patients in the reconstruction group and 74 patients in the nonreconstruction group. There were 47 males and 25 females in the reconstruction group, aged (59.75 ± 6.2) years, with a body mass index (BMI) (24.1 ± 2.2) kg/m2, and 51 males and 23 females in the nonreconstruction group, aged (58.77 ± 6.1) years, with a BMI (23.6 ± 2.7) kg/m2. There was no significant difference in the baseline data between the two groups (P > 0.05). In the submesenteric artery reconstruction group, 35 patients were type I, 25 patients were type II, 11 patients were type III, and 1 patient was type IV. There were 37 type I patients, 24 type II patients, 12 type III patients, and 1 type IV patient in the nonreconstruction group. There was no significant difference in arterial typing between the two groups (P > 0.05). The operation time of the reconstruction group was 162.2 ± 10.8 min, and that of the nonreconstruction group was 197.9 ± 19.1 min. Compared with that of the reconstruction group, the operation time of the two groups was shorter, and the difference was statistically significant (t = 13.840, P < 0.05). The amount of intraoperative blood loss was 30.4 ± 20.0 mL in the reconstruction group and 61.2 ± 26.4 mL in the nonreconstruction group. The amount of blood loss in the reconstruction group was less than that in the control group, and the difference was statistically significant (t = -7.930, P < 0.05). The rates of anastomotic leakage (1.4% vs 1.4%, P = 0.984), anastomotic hemorrhage (2.8% vs 4.1%, P = 0.672), and postoperative hospital stay (6.8 ± 0.7 d vs 7.0 ± 0.7 d, P = 0.141) were not significantly different between the two groups.
CONCLUSIONS: Preoperative 3D vascular reconstruction technology can shorten the operation time and reduce the amount of intraoperative blood loss. Preoperative 3D vascular reconstruction is recommended to provide an intraoperative reference for laparoscopic low anterior resection with LCA preservation.
摘要：
背景：腹腔镜低位前切除术（LLAR）已成为治疗结直肠癌的主流手术方法，在手术创伤和术后康复方面表现出许多优势。然而,手术对患者左冠状动脉及其血管重建的影响尚未深入讨论。随着医学影像技术的发展,三维血管重建已成为评价手术疗效的有效手段。
目的：探讨保留左结肠动脉(LCA)的直肠癌LLAR术前三维血管重建的临床价值。
方法：采用回顾性队列研究方法，对2023年1月至12月在我院行LCA保存术的146例直肠癌患者的临床资料进行分析。所有患者均接受LCA保留的直肠癌LLAR，术中和术后数据完整。根据术前是否进行3D血管重建，将患者分为重建组（72例）和非重建组（74例）。临床特征，操作条件,并发症,收集并比较两组患者的病理结果及术后恢复情况。
结果：共有146例直肠癌患者被纳入研究，包括重建组72例患者和非重建组74例患者。重建组有47名男性和25名女性，年龄（59.75±6.2）岁，体重指数（BMI）（24.1±2.2）kg/m2，非重建组中男性51例，女性23例，年龄（58.77±6.1）岁，BMI为（23.6±2.7）kg/m2。两组基线资料比较差异无统计学意义(P>0.05)。肠系膜下动脉重建组,35例患者为I型，25例患者为II型，11例患者为III型，1例患者为IV型。有37名I型患者,24名II型患者，12名III型患者，非重建组1例IV型患者。两组间动脉分型差异无统计学意义(P>0.05)。重建组手术时间为162.2±10.8min,非重建组为197.9±19.1分钟。与重建组相比，两组手术时间较短,差异有统计学意义(t=13.840,P<0.05)。术中失血量重建组为30.4±20.0mL，非重建组为61.2±26.4mL。重建组的失血量少于对照组，差异有统计学意义(t=-7.930,P<0.05)。吻合口漏的发生率（1.4％vs1.4％，P=0.984),吻合口出血（2.8％vs4.1％，P=0.672),术后住院时间（6.8±0.7dvs7.0±0.7d，P=0.141)两组间无显著差异。
结论：术前三维血管重建技术可缩短手术时间，减少术中出血量。建议术前3D血管重建，为腹腔镜下保留LCA的低位前切除术提供术中参考。
目的：探讨保留左结肠动脉(LCA)的直肠癌LLAR术前三维血管重建的临床价值。
方法：采用回顾性队列研究方法，对2023年1月至12月在我院行LCA保存术的146例直肠癌患者的临床资料进行分析。所有患者均接受LCA保留的直肠癌LLAR，术中和术后数据完整。根据术前是否进行3D血管重建，将患者分为重建组（72例）和非重建组（74例）。临床特征，操作条件,并发症,收集并比较两组患者的病理结果及术后恢复情况。
结果：共有146例直肠癌患者被纳入研究，包括重建组72例患者和非重建组74例患者。重建组有47名男性和25名女性，年龄（59.75±6.2）岁，体重指数（BMI）（24.1±2.2）kg/m2，非重建组中男性51例，女性23例，年龄（58.77±6.1）岁，BMI为（23.6±2.7）kg/m2。两组基线资料比较差异无统计学意义(P>0.05)。肠系膜下动脉重建组,35例患者为I型，25例患者为II型，11例患者为III型，1例患者为IV型。有37名I型患者,24名II型患者，12名III型患者，非重建组1例IV型患者。两组间动脉分型差异无统计学意义(P>0.05)。重建组手术时间为162.2±10.8min,非重建组为197.9±19.1分钟。与重建组相比，两组手术时间较短,差异有统计学意义(t=13.840,P<0.05)。术中失血量重建组为30.4±20.0mL，非重建组为61.2±26.4mL。重建组的失血量少于对照组，差异有统计学意义(t=-7.930,P<0.05)。吻合口漏的发生率（1.4％vs1.4％，P=0.984),吻合口出血（2.8％vs4.1％，P=0.672),术后住院时间（6.8±0.7dvs7.0±0.7d，P=0.141)两组间无显著差异。
结论：术前三维血管重建技术可缩短手术时间，减少术中出血量。建议术前3D血管重建，为腹腔镜下保留LCA的低位前切除术提供术中参考。
