肠系膜下动脉低位结扎及根部淋巴结廓清在腹腔镜低位前切除手术中的临床意义

Clinical significance of low ligation of inferior mesenteric artery and lymph nodes dissection in laparoscopic low anterior resection

目的:探讨腹腔镜低位前切除(low anterior resection,LAR)术中行肠系膜下动脉(inferior mesenteric artery,IMA)低位结扎及根部淋巴结廓清的临床意义。方法:2011年10月至2013年10月为114例直肠癌患者行腹腔镜LAR,随机分为对照组(n=55)与观察组(n=59)。观察组采用IMA低位结扎及根部淋巴结廓清;对照组采用IMA高位结扎术及根部淋巴结廓清。对比分析手术时间、淋巴结清扫数量、吻合口漏发生率及术后首次通气时间。结果:手术时间、淋巴结清扫数量、吻合口漏发生率两组差异无统计学意义(P>0.05);术后首次通气时间观察组少于对照组,差异有统计学意义(P<0.05)。结论:LAR术中行IMA低位结扎及根部淋巴结廓清优于IMA高位结扎术及根部淋巴结廓清,具有推广应用的价值。

Objective ：To evaluate the clinical significance of low ligation of inferior mesenteric artery （IMA） and lymph nodes dissection in laparoscopie low anterior resection. Methods ： Data were retrospectively collected from 114 rectal cancer patients who un- derwent laparoscopic low anterior resection in our hospital from Oct. 2011 to Oct. 2013. Patients were randomly divided into control group （55 cases） and observation group （59 cases）. The observation group was treated with low ligation of IMA and lymph nodes dis- section, the control group was cured by high ligation of IMA and lymph nodes dissection. The operation time, the number of lymph nodes dissection, the incidence of anastomotie leakage and the ventilation time after the operation were compared and analyzed. Results： Thgre was no significant difference between the two groups in the operation time, the number of lymph nodes dissection and the incidence of anastomotic leakage （ P 〉 0.05 ）. The observation group was significantly better than control group in the ventilation time after the oper- ation （ P 〈 0.05 ）. Conclusions ： Low ligation of IMA and lymph nodes dissection in laparoscopie low anterior resection is better than high ligation of IMA and lymph nodes dissection,it should be widely applied in clinic.