肠系膜下动脉高位与低位结扎合并根部淋巴结清扫在腹腔镜低位直肠癌根治术中的近期疗效对比

doi:10.3969/j.issn.1005-6483.2019.09.020

摘要/Abstract

摘要： 目的:探讨肠系膜下动脉（IMA）低位结扎与高位结扎并根部淋巴结清扫在腹腔镜低位直肠癌根治术中的应用，并比较其手术疗效。方法:2015年4月～2018年1月我院肛肠外科收治的低位直肠癌接受腹腔镜直肠癌根治术病人92例，按照术中IMA结扎方式分为高位组（52例）和低位组（40例），比较两组手术时间、失血量、IMA根部淋巴结清扫数目、住院时间、术后并发症发生率及排便功能等。结果:两组手术时间分别为（142.24±20.25）分钟和（146.24±22.64）分钟，失血量分别为（40.36±6.18）ml和（44.66±7.22）ml，淋巴结清扫数目分别为（14.24±2.18）枚和（13.94±2.07）枚，住院时间分别为（11.49±3.14）天和（12.48±3.85）天，两组比较差异无统计学意义（P>0.05）；低位组和高位组首次排气时间分别为（36.63±2.78）小时和（44.48±4.21）小时，两组比较差异有统计学意义（P＜0.05）。低位组术后3个月、6个月排便功能评分优于高位组，差异有统计学意义（P＜0.05）。低位组吻合口漏发生率为2.5%（1/40），低于高位组的5.78%（3/52），差异有统计学意义（P＜0.05）。低位组术后尿失禁或性功能障碍发生率17.5%（7/40），高于高位组的7.69%（4/52），差异有统计学意义（P＜0.05）。其余各术后并发症发生率差异无统计学意义（P＞0.05）。结论:两种结扎方式在腹腔镜直肠癌根治术中具有相同疗效，但低位结扎对排便功能影响小，吻合口漏发生率低，具有更好的近期疗效。

关键词: 肠系膜下动脉, 腹腔镜, 直肠癌

Abstract: Objective:To analyze and compare the effect of low ligation and high ligation of inferior mesenteric artery（IMA）and root lymph node dissection in laparoscopic radical resection of low rectal cancer.Methods:The clinical data of 92 patients with low rectal cancer who underwent laparoscopic radical resection from April 2015 to March 2018 were analyzed retrospectively.According to the mode of intraoperative IMA ligation，the patients were divided into high group（n=52）and low group（n=40）.The operation time，blood loss，number of IMA root lymph node dissection，hospitalization time ，postoperative complication rate and defecation function were compared between the two groups.Results:There was no significant difference in operation time [（142.24±20.25）min VS（146.24±22.64）min]，blood loss [（40.36±6.18）ml VS（44.66±7.22）ml]，lymph node dissection number [（14.24±2.18）VS（13.94±2.07）]，hospitalization time [（11.49±3.14）d VS（12.48±3.85）d] between the two groups（P>0.05）.The first exhaust time of the low group was lower than that of the high group [（36.63±2.78）h VS（44.48±4.21）h].The defecation function score of the two groups at 3 months and 6 months after operation was better than that of the high group，and the difference was statistically significant（P<0.05）.The incidence of anastomotic leakage in the low group was 2.5%（1/40），lower than that in the high group [5.78%（3/52）].The difference was statistically significant（P<0.05）.The incidence of urinary incontinence or sexual dysfunction in low group was 17.5%（7/40），higher than that in high group[7.69%（4/52）]，the difference was statistically significant（P<0.05）.There was no significant difference in the incidence of other complications（P＞0.05）.onclusion:The two kinds of ligation have similar curative effect in laparoscopic radical resection of rectal cancer，but low ligation has less influence on defecation function，lower incidence of anastomotic leakage and better shortterm curative effect.

Key words: inferior mesenteric artery, laparoscopy, rectal cancer

张鹏, 黄东, 刘全. 肠系膜下动脉高位与低位结扎合并根部淋巴结清扫在腹腔镜低位直肠癌根治术中的近期疗效对比[J]. 临床外科杂志, 2019, 27(9): 783-786.

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