IMA分型、Riolan动脉弓是否缺失与直肠癌根治术后吻合口漏的关系研究

The relationship between IMA classification, absence of Riolan arterial arch and anastomotic leakage after radical resection of rectal cancer

目的研究直肠癌根治术后吻合口漏与肠系膜下动脉(inferior mesenteric artery,IMA)分型及Riolan动脉弓的关系。方法回顾性分析本院90例接受直肠癌根治术的患者临床病历资料,根据术后是否发生吻合口漏分为观察组(发生吻合口漏)和对照组(未发生吻合口漏),比较两组临床病理参数差异,采用Logistic多因素回归分析法探讨术后发生吻合口漏的危险因素。结果90例患者中,共发生吻合口漏8例,其中6例发生于IMA Ⅲ型(占75%,均为Riolan动脉弓缺失和高位结扎患者)。两组在IMA分型、IMA结扎部位和Riolan动脉弓是否缺失的分布差异均有统计学意义(均P<0.05)。纳入Logistic多因素回归分析模型,结果显示IMA Ⅲ型和Riolan动脉弓缺失是术后发生吻合口漏的独立危险因素(均P<0.05)。结论 IMA Ⅲ型和Riolan动脉弓缺失是直肠癌根治术后发生吻合口漏的独立危险因素,对于IMA Ⅲ型和Riolan动脉弓缺失患者,建议考虑采用IMA低位结扎方式,或可降低术后吻合口漏发生率。

Objective To study the relationship between anastomotic leakage and inferior mesenteric artery（IMA） classification and absence of Riolan arterial arch after radical resection of rectal cancer. Methods We performed a retrospective analysis of 90 patients with rectal cancer who received radical resection in our hospital. Patients were divided into anastomotic leakage group and control group with no anastomotic leakage, according to the presence of postoperative anastomotic leakage. Clinical pathological parameters were compared between the two groups using Logistic multivariate analysis to investigate the risk factors for anastomotic leakage.Results Anastomotic leakage occurred in 8 out of 90 patients, 6 of which occurred in IMA type Ⅲ（75%）. All of the 6 patients had absence of Riolan arterial arch and high ligation. There were significant differences between the two groups in IMA type, IMA ligation sites and the absence of Riolan artery arch（P〈0.05）. Logistic multivariate regression analysis showed that IMA type Ⅲ and absence of Riolan arch were independent risk factors for anastomotic leakage after operation（P〈0.05）. Conclusion IMA type Ⅲ and absence of Riolan arch are the independent risk factors of anastomotic leakage after radical resection in patients with rectal carcinoma. IMA low ligation should be considered in these patients to reduce the risk of postoperative anastomotic leakage.