肠系膜下动脉低位结扎在腹腔镜直肠癌根治术患者中的应用

Application of lower ligation of inferior mesenteric artery in patients undergoing laparoscopic radical resection of rectal cancer

目的探讨肠系膜下动脉低位结扎在腹腔镜直肠癌根治术患者中的应用效果。方法回顾性分析2015年1月~2016年12月我院收治的85例腹腔镜直肠癌根治术患者的临床资料。按术中肠系膜结扎部位的不同分为两组,术中行肠系膜下动脉低位结扎患者45例作为低位组,术中行肠系膜下动脉高位结扎患者40例作为高位组,比较两组患者术中淋巴结清扫数目、手术操作指标与恢复指标、术后并发症;并随访至2019年12月31日,比较两组患者术后3年的累积生存率。结果两组患者的手术时间、术中出血量、住院时间、淋巴结清扫总数目、第三站淋巴结清扫数目、第三站淋巴结转移率及3年累积生存率比较,差异无统计学意义(P>0.05),低位组患者的排气时间短于高位组,术后并发症总发生率为4.44%,低于高位组的25.00%,差异有统计学意义(P<0.05)。结论腹腔镜直肠癌根治术中肠系膜下动脉低位结扎的应用,其生存率、淋巴结清扫与高位结扎相一致,但肠系膜下动脉低位结扎可相应减少术后吻合口漏的发生,安全性高,值得应用。

Objective To investigate the effect of lower ligation of inferior mesenteric artery in patients undergoing laparoscopic radical resection of rectal cancer.Methods The clinical data of 85 patients undergoing laparoscopic radical resection of rectal cancer treated in our hospital from January 2015 to December 2016 were retrospectively analyzed.Divided into two groups according to the different mesenteric ligation sites during operation,45 patients with low ligation of inferior mesenteric artery during operation were regarded as low group,and 40 patients with high ligation of inferior mesenteric artery during operation were regarded as high group.The number of intraoperative lymph node dissection,surgical operation index and recovery index,and postoperative complications were compared between the two groups of patients;follow-up to December 31,2019 and the 3-year cumulative survival rate of the two groups of patients were compared.Results There were no significant differences in surgical time,intraoperative blood loss,length of hospital stay,total number of lymph node dissections,number of lymph node dissections at the third station,lymph node metastasis rate at the third station and 3-year cumulative survival rate between the two groups of patients(P>0.05).The exhaust time of the lower group was shorter than that of the high group,and the total incidence of postoperative complications was 4.44%,lower than that of the high group,accounting for 25.00%,and the differences were statistically significant(P<0.05).Conclusion The application of lower ligation of inferior mesenteric artery in laparoscopic radical resection of rectal cancer has the same survival rate and lymph node dissection as the high ligation of inferior mesenteric artery.However,lower ligation of inferior mesenteric artery can reduce the incidence of postoperative anastomotic leakage,which is highly safe and worthwhile application.