肠系膜下动脉低、高位结扎对直肠癌手术效果及患者生命质量的影响

目的探讨肠系膜下动脉(IMA)低、高位结扎对直肠癌手术效果及患者生命质量的影响。方法按随机数字表法将90例直肠癌患者分为两组,各45例。两组患者均行腹腔镜下全直肠系膜切除(TME)联合淋巴结清扫术治疗,术中低位组行IMA低位结扎,高位组行IMA高位结扎。对比两组手术效果、排便功能、生命质量、并发症情况。结果对比两组淋巴结清扫数量、手术用时、住院时间、术中失血量无统计学差异(P>0.05);高位组肛门排气时间长于低位组,排便功能评分低于低位组,有统计学差异(P<0.05);对比两组术后生命质量评分、吻合口瘘、泌尿感染、尿潴留发生率无统计学差异(P>0.05);与对照组相比,高位组吻合口瘘发生率高,有统计学差异(P<0.05)。结论直肠癌患者行IMA低、高位结扎疗效和生命质量相当,前者能缩短术后肛门排气时间,减少吻合口瘘发生率,后者对患者排便功能影响小,临床可根据患者实际情况合理选择术式。

Effect of Low and High Ligation of Inferior Mesenteric Artery on Surgical Effect and Quality of Life of Patients with Rectal Cancer

Objective To investigate the effect of low and high ligation of inferior mesenteric artery(IMA)on rectal cancer surgery and quality of life.Methods 45 patients with rectal cancer were randomly divided into 2 groups.Laparoscopic total mesorectal excision(TME)combined with lymph node dissection was performed in both groups.Low IMA ligation was performed in low group and high ligation in high group.The operation effect,defecation function,quality of life and complications were compared between the 2 groups.Results There was no significant difference in the number of lymph node dissection,operative time,hospital stay and blood loss of the 2 groups(P>0.05).The anal exhaust time in the high group was longer than that of the low group,and the defecation function score was lower than that of the low group(P*0.05).There was no significant difference in the postoperative birth quality score,anastomotic leakage,urinary infection and urinary retention between the 2 groups(P>0.05).Compared with the control group,the incidence of anastomotic leakage in the high position group was higher(P<0.05).Conclusion The curative effect and quality of life of patients with rectal cancer treated by IMA low and high ligation are similar.The former can shorten the anal exhaust time and reduce the incidence of anastomotic leakage,while the latter has little impact on the defecation function of patients.The operation mode can be selected reasonably according to the actual situation of patients.