肠系膜下动脉不同处理方式对直肠癌根治术影响的对比研究

Comparative study on effects of different treatments on inferior mes- enteric artery in resection of rectal cancer

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廓清对直肠癌根治术的意义。方法对2007年5月—2008年5月收治的156例直肠癌患者进行回顾性分析，低位结扎组80例，高位结扎组76例。低位结扎组采用肠系膜下动脉低化结扎并根部淋巴结廓清，高位结扎组采用肠系膜下动脉高位结扎斤根部淋巴结廓清。比较两组IMA根部淋巴结转移率、淋巴结清扫数量、复发率、5年生存牢及并发症发病率，并进行统计学分析。结果低位结扎组IMA根部淋巴结转移率为15．0％，高位结扎组IMA根部淋巴结转移率为14．5％，两组比较差异无统计学意义（P〉0．05）；对比两组术后复发率、5年生存率、吻合口瘘、性功能障碍和尿潴留的发病率，差异均无统计学意义（P〉0．05）；低位结扎组肠道功能恢复时间、低位直肠前切除综合征的发病率低于高位结扎组，两组比较差异有统计学意义（P〈0．05）。结论肠系膜下动脉低位结扎并根部淋巴结廓清可达到直肠癌根治。与传统IMA高位结扎相比，对患苦的复发率、5年生存率及并发症发病率无影响。

Objective To evaluate the clinical significance of low ligation and high ligation of inferior mesenteric artery （ IMA ） and lymph nodes dissection on radical resection for rectal cancer. Methods One hundred and fifty-six patients who were diagnosed rectal cancer in our hospital between May 2007 and May 2008 were divided into low ligafion group （80 cases）and high ligation group （76 cases）. The low ligation group was treated with low ligation of IMA and lymph nodes disseetion, the high ligation group was cured by high ligation of IMA and lymph nodes dissection. eases. The IMA lymph nodes metastasis, number of lymph nodes, cancer reeurernee rate, 5-year smwival rate, complication rate were compared and analyzed. Results The rate of lymph nodes metastasis around the origin of inferior mesenteric artery was 15.0% in the low ligation group, the rate of lymph nodes metastasis around the origin of inferior mesenteric artery was 14.5% in the high ligation group, and the difference was not statistically significant （P 〉 0.05 ）. Compared two groups of postoperative recurrence rate, 5- year survival rate, anastomotic leakage rate, sexual dysfunction rate and urinary retention rate, there was no significant differences （ P 〉 0. 05 ）. The intestinal fimction recovery time and low anterior resection syndrome incidence of the low ligation group were lower than the high ligation group, there were significant differences （P 〈 0.05 ）. Conclusions Low ligation of inferior mesenteric artery and lymph nodes dissection can achieve radical resection for rectal cancer. Compared with traditional high ligation of inferior mesenteric artery, there were no differences for patients on recurrence rate, 5- year survival rate and complica- tion rate.