腹腔镜低位前切除手术中行肠系膜下动脉低位结扎及根部淋巴结廓清的可行性探讨

Clinical possibility 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手术中行肠系膜下动脉低位结扎及根部淋巴结廓清的可行性。方法回顾性分析首都医科大学附属北京朝阳医院普外科腹腔镜专业组在2010年6月至2015年1月行腹腔镜低位前切除（LAR）手术216例患者，根据肠系膜下动脉结扎部位不同分为实验组（132例）和对照组（84例）。实验组采用肠系膜下动脉（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。统计比较两组术前一般资料及手术时间、总淋巴结清扫个数、IMA根部淋巴结清扫数目、IMA根部淋巴结转移率、吻合口瘘发生率及术后首次通气时间。结果术前两组患者一般情况差异无统计学意义。两组患者手术时间、淋巴结清扫个数、IMA根部淋巴结清扫数目、IMA根部淋巴结转移率、吻合口瘘发生率两组差异无统计学意义；术后首次通气时间实验组（36.4±7.6） h少于对照组（45.7±9.3） h（P＝0.032）。两组患者随访时间12～67个月，中位数37个月，实验组1例患者因心血管并发症在术后36个月死亡，对照组1例患者术后24个月，因直肠癌全身转移死亡。结论腹腔镜低位前切除手术时进行肠系膜下动脉低位结扎及根部淋巴结廓清安全、可行，有利于术后恢复，值得推广。

ObjectiveTo investigate the clinical possibility of low ligation of inferior mesenteric artery （IMA） and lymph nodes dissection in laparoscopic low anterior resection.MethodsData was collected retrospectively from 216 patients who underwent laparoscopic low anterior resection in our hospital from June 2011 to January 2015.Patients were divided into control group （132 cases） and observation group （84 cases）. The observation group was treated with low ligation of IMA and lymph nodes dissection, and the control group was cured by high ligation of IMA and lymph nodes dissection. We analyzed the operation time, the number of lymph nodes dissection, the number of lymph nodes removed around the root of IMA, the rate of lymph node metastasis around the root of IMA, the incidence of anastomotic leakage and the ventilation time after the operation.ResultsThere was no significant difference between the two group in the pre-operative data, operation time, the number of lymph nodes dissection the number of lymph nodes removed around the root of IMA, the rate of lymph node metastasis around the root of IMA and the incidence of anastomotic leakage （P〉0.05）. The observation group were significantly better than the control group the in the ventilation time after the operation （P〈0.05）. The follow up time was 12 to 67 months. The median follow up time was 37 months. One patient in observation group died of cardiovascular disease. One patient in control group died of metastatic carcinoma.ConclusionDetection of low ligation of inferior mesenteric artery and lymph nodes dissection in laparoscopic low anterior resection is safe and practicable, which should be widely applied.