肠系膜下动脉高位结扎对直肠癌切除术后预后的影响

High ligation of the inferior mesenteric artery affect patient prognosis following resection of rectal cancer

目的：探讨肠系膜下动脉高位结扎(high ligation,HL)对直肠癌切除术后并发症、生存率和复发率的影响。方法：回顾性研究了我院自1993年6月至1998年12月间收治的369例直肠癌患者。结果：HL组158例(42.8％)和非HL组211例(57.2％)。在性别、年龄、肿瘤部位、手术方式、手术时间、术中估计失血量及输血量、大体标本类型、病理组织学类型、肿瘤占据肠腔周径及Astler-Coller分期上，两组相比无显著性差异(P>0.05)。IMA(inferior mesenteric artery)根部淋巴结转移率11.1％(41/369)。HL组术后并发症发生率为17.7％(28/158)，与非HL组相接近(21.8％，46/211)；HL组术后3年和5年生存率分别为78.3％和56.2％，而非HL组分别为68.7％和50.4％，两组相比无明显差异(P>0.05)。AstlerCollerC1期术后3年和5年生存率在HL组分别为90.2％和65.1％，而在非HL组分别为84.4％和57.2％；C2期术后3年和5年生存率在HL组分别为77.2％和46.3％，而在非HL组分别为69.4％和41.6％，两组相比均无明显差异(P>0.05)。HL组术后复发率为20.3％(32/158)，而非HL组则为21.8％(46/211)，两组无明显差异(P>0.05)；HL组与非HL组术后复发时间分别为(16.6±3.1)和(12.7±2.5)个月，前者复发时间迟于后者(P<0.05)。结论：HLIMA对直肠癌术后并发症、

Objective： To explore effect of high ligation of the inferior mesenteric artery (HLIMA) on morbidity, survival and recurrence rates following resection of rectal cancer. Methods： A total of 369 patients with rectal cancer from June 1993 to December 1998 were analyzed retrospectively. Results： One hundred fifty eight patients were treated with HLIMA (42.8％ ), and the other 211 patients without HLIMA (57.2％ ). There were no significant differences between the HLIMA and non HLIMA group in terms of mean age, sex distribution, type of resection, operative time, intraoperative estimated blood loss and blood transfusion. The two groups were similar in level of tumor, histopathologic type, appearance of general specimen, and a range of the circumference of the bowel encircled by a tumor. The incidence of metastases to the lymph nodes surrounding the origin of the inferior mesenteric artery (IMA) (root nodes) was 11.1％ (41/369). The morbidity of postoperative complications was 17.7％ in the HLIMA group, and 21.8％ in the non HLIMA group, respectively. The three year survival rate increased from 68.7％ to 78.3％ and the five year survival rate from 50.4％ to 56.2％ with HLIMA. But there was not significant difference between the two groups (P >0.05). The survival rates were similar in the HLIMA and non HLIMA group (P >0.05), respectively 90.2％ versus 84.4％ at three years and 65.1％ versus 57.2％ at five years in C1 tumors, while in C2 tumors the results were 77.2％ versus 69.4％ at three years and 46.3％ versus 41.6％ at five years. The postoperative recurrence rate was unaffected by HLIMA (P >0.05), respectively 20.3％ (32/158) in the HLIMA group and 21.8％ (46/211) in the non HLIMA group. But postoperative recurrence time in the HLIMA group, which was significantly prolonged, was (16.6± 3.1) months compared with (12.7± 2.5) months in the non HLIMA group (P< 0.05). Conclusion： The morbidity, survival and recurrence rates following resection of rectal cancer are not significantly affected by HLIMA, but recurrence time in the HLIMA group is significantly prolonged.