肠系膜下动脉低、高位结扎在腹腔镜直肠癌根治术中的效果比较

目的:探讨低、高位结扎肠系膜下动脉(IMA)在腹腔镜直肠癌根治术中的临床疗效、应用价值及患者术后生存情况。方法:回顾分析2014年1月至2017年1月收治的215例直肠癌患者的临床资料,根据IMA结扎方式分为低位结扎组(n=98)与高位结扎组(n=117)。对比分析两组患者一般情况、围手术期相关指标(手术时间、术中出血量、淋巴结清扫数量、IMA根部清扫淋巴结数量、肛门排气时间、住院时间、住院费用)、手术并发症发生率(吻合口漏、肠梗阻、尿潴留、泌尿系统感染)及生存情况(3年总生存率、肿瘤远处转移率、复发率)。结果:两组手术时间(153.60±8.04)min vs.(149.40±9.71)min]、术中出血量(79.30±20.61)mL vs.(69.20±20.13)mL]、淋巴结清扫数量(15.90±2.26)枚vs.(17.10±2.72)]枚、IMA根部淋巴结清扫数量(3.20±1.23)枚vs.(3.30±1.42)枚]差异均无统计学意义(P>0.05),低位组与高位组的肛门排气时间(24.40±8.54)h vs.(34.20±8.65)h]、住院时间(9.30±3.43)d vs.(12.50±3.24)d]、医疗费用(38500±6381.40)元vs.(47700±11888.84)元]差异有统计学意义(P<0.05)。低位组吻合口漏发生率为2%,低于高位组的8.5%,差异有统计学意义(P<0.05),其余术后并发症发生率差异无统计学意义(P>0.05)。两组患者3年总生存率(76.9%vs.79.5%)、肿瘤远处转移率(11.1%vs.12.2%)、复发率(6.8%vs.8.1%)差异无统计学意义(P>0.05)。结论:与高位结扎IMA相比,腹腔镜直肠癌根治术中低位结扎IMA利于术后肠道功能的恢复,降低了吻合口漏发生率,提高了近期疗效。

Comparison of the effects of low and high ligation of the inferior mesenteric artery in laparoscopic radical resection of rectal cancer

Objective:To investigate the clinical efficacy,application value and postoperative survival of patients who underwent low or high ligation of inferior mesenteric artery(IMA)in laparoscopic radical resection of rectal cancer.Methods:The clinical data of 215 patients with rectal cancer from Jan.2014 to Jan.2017 were retrospectively analyzed.According to the ligation method of IMA,215 patients were divided into low ligation group(low ligation of IMA,n=98)and high ligation group(high ligation of IMA,n=117).The general conditions of patients,perioperative indicators(operative time,intraoperative blood loss,number of lymph node dissection,the number of IMA root lymph nodes dissection,the postoperative exhaust time,hospital stay,medical expenses),incidence of perioperative complications(anastomotic leakage,intestinal obstruction,retention of urine,urinary tract infection)and postoperative survival(3-year total survival rate,the tumor metastasis rate and recurrence rate)were analyzed and compared between the two groups.Results:There was no statistically significant difference in operative time(153.60±8.04)min vs.(149.40±9.71)min],intraoperative blood loss(79.30±20.61)mL vs.(69.20±20.13)mL],the number of dissected lymph nodes(15.90±2.26)vs.(17.10±2.72)],the number of dissected IMA root lymph nodes(3.20±1.23)vs.(3.30±1.42)]between the two groups(P>0.05).The low ligation group had significantly shorter anal exhaust time(24.40±8.54)h vs.(34.20±8.65)h],shorter hospital stay(9.30±3.43)d vs.(12.50±3.24)d]and lower medical expenses(38500±6381.40)yuan vs.(47700±11888.84)yuan].Compared with the high ligation group,the low ligation group had significantly lower incidence of anastomotic leakage(2%vs.8.5%,P<0.05).There was no significant difference in the incidence of other postoperative complications between the two groups(P>0.05).There were no statistically significant differences in the 3-year overall survival rate(76.9%vs.79.5%),tumor distal metastasis rate(11.1%vs.12.2%)and recurrence rate(6.8%vs.8.1%)between the two groups(P>0.05).Conclusions:Compared with the high ligation,low ligation of the IMA during laparoscopic radical resection of rectal cancer is beneficial to the recovery of intestinal function after operation and appears to be associated with a lower incidence of anastomotic leakage and better short-term curative effect.