低位结扎IMA与高位结扎IMA治疗直肠癌的手术疗效及术后生命质量比较  

Comparison of surgical efficacy and postoperative quality of life of patients with rectal cancer treated by low ligation and high ligation of IMA

作　　者：黄进林 严伟华[1] 伍志辉[1] 

机构地区：[1]广州中医药大学顺德医院普通外科,广东顺德528000

出　　处：《广州医科大学学报》2017年第3期69-72,共4页Academic Journal of Guangzhou Medical University

摘　　要：目的:观察比较地位结扎肠系膜下动脉(IMA)与高位结扎IMA手术治疗直肠癌的临床疗效以及术后患者生命质量。方法:选取我院2013年9月至2016年9月直肠癌患者76例,按照手术方式的不同将患者分为两组,每组38例,将实施低位结扎IMA手术的患者设置为低位结扎组,另实施高位结扎IMA手术的患者设置为高位结扎组,比较两组各项手术指标水平差异及并发症发生率,对患者进行为期3个月的随访比较两组排便功能、生活质量水平差异。结果:低位结扎组排气时间较高位结扎组显著较短(P<0.05);低位结扎组术后低位前切除综合征发生率为15.79%较高位结扎组44.74%显著较低(P<0.05);术后3个月低位结扎组患者每日排便次数较高位结扎组显著较少,夜间失禁发生率较高位结扎组显著较低(P<0.05);低位结扎组患者术后各项生活质量水平较高位结扎组显著较高(P<0.05)。结论:高位结扎与低位结扎IMA均能对直肠癌患者淋巴进行彻底清扫,两种术式的疗效均值得肯定,而低位结扎IMA通过保留了患者近端结肠供血,对患者术后排便功能影响较小,患者生命质量水平更高,值得临床应用推广。Objective：To observe the clinical efficacy and the quality of life of patients with rectal cancer treated by low ligation and high ligation of inferior mesentericartery （IMA）.Methods：A total of 76 patients with rectal cancer treated in our hospital during September 2013 to September 2016 were divided into two groups according to the different surgical methods,38 cases in each group. Patients undergoing low ligation of IMA were included into the low ligation group while patients undergoing high ligation of IMA were included into the high ligation group. The surgical indicators and the incidence of complications were compared between the two groups. All patients were followed up for 3 months to compare the defecation function and quality of life. Results：The exhaust time of the low ligation groupwas significantly shorter thanthe high ligation group （ P〈0. 05 ） . The incidence of low anterior resection syndrome was significantly lower in the low ligation group than the high ligation group （15.79% vs 44.74%） （P〈0.05）. 3 months after surgery,the frequency of daily defecationof low ligation group was significantly lower and the incidence of nocturnal incontinence rate was significantly lower than the high ligation group （ P〈0.05） . After surgery,quality of life of the low ligation group was significantly better than that of the high ligation group（P〈0.05）.Conclusion：Both of high ligation and low ligation of IMA are effective in removing lymph nodes in patients with rectal cancer. The low ligation of IMA has less effect on defecation function after surgery by retaining the proximal colon blood supply and quality of life of patients is better.

关 键 词：低位结扎IMA 高位结扎IMA 直肠癌 疗效 生命质量 

分 类 号：R735.3[医药卫生—肿瘤]