IMA结扎方案对男性腹腔镜直肠癌患者手术效果及盆腔植物神经功能的影响  

Effect of IMA ligation scheme on operative effect and pelvic autonomic nerve function in male laparoscopic rectal cancer patients

作　　者：刘佩杰 LIU Pei-jie(Armed Police Sichuan General Hospital General Surgery,Sichuan Leshan,617000,China)

机构地区：[1]武警四川总队医院普外科,617000

出　　处：《现代消化及介入诊疗》2019年第4期352-356,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：四川省科技攻关计划项目(2016K0200101)

摘　　要：目的探讨腹腔镜直肠癌根治术中肠系膜下动脉(IMA)高位与低位结扎对男性患者手术效果及盆腔植物神经功能的影响。方法回顾性分析2015年5月至2017年6月接受腹腔镜根治术的187例男性直肠癌患者病历资料,按IMA结扎方案将其划分为高位结扎组(103例)与低位结扎组(84例)。对比两组术中及院内恢复情况,术后病理学检查情况,持续随访,观察术后中远期排尿功能障碍、勃起功能障碍、射精功能障碍发生率及预后。结果高位结扎组手术时间(138. 17±17. 52)min,明显短于低位结扎组(147. 62±15. 35) min,高位结扎组术后排气时间(78. 13±4. 12) h,明显长于低位结扎组(72. 62±4. 47) h,高位结扎组术后吻合口瘘发生率20. 39%,明显高于低位结扎组8. 33%,差异有统计学意义(P <0. 05)。两组患者术后pT分期、N分期、组织分型、第3站淋巴结转移情况、淋巴结清扫数对比,差异均无统计学意义(P> 0. 05)。高位结扎组中远期勃起功能障碍、射精功能障碍发生率分别为6. 80%、5. 83%明显低于低位结扎组25. 00%、20. 24%,差异有统计学意义(P <0. 05)。两组复发转移率及死亡率对比,差异无统计学意义(P> 0. 05)。结论男性患者腹腔镜直肠癌根治术中,IMA高位结扎与低位结扎能获得相近的手术效果及预后,但后者有助于促进术后恢复,减少吻合口瘘风险,而前者有助于保护患者盆腔植物神经。Objective To investigate the effect of high or low ligation of the inferior mesenteric artery(IMA)in laparoscopic radical resection of rectal cancer on the surgical outcome and pelvic autonomic nerve function in male patients.Methods 187 patients with rectal cancer treated with laparoscopic radical resection from May 2015 to June 2017 were analyzed retrospectively.They were divided into high ligation group(103 cases)and low ligation group(84 cases)according to IMA ligation scheme.The postoperative nosocomial recovery and pathological examination indexes were compared between the two groups.All cases were continuously followed up,the incidence of voiding dysfunction,erectile dysfunction,ejaculation dysfunction and prognosis were observed.Results The operative time of the high ligation group was(138.17±17.52)min,which was shorter than that of the low ligation group[(147.62±15.35)min],and the postoperative exhaust time of the high ligation group was(78.13±4.12)h,which was longer than that of the low ligation group[(72.62±4.47)h],the incidence of anastomotic leakage of the high ligation group was 20.39%,which was higher than that of the low ligation group(8.33%,P<0.05).There was no significant difference between the two groups in pT stage,N stage,histological type,lymph node metastasis at the third station,and harvested lymph node number(P>0.05).The incidence of erectile dysfunction and ejaculatory dysfunction in the high ligation group were 6.80%and 5.83%,which were significantly lower than those in the low ligation group(25.00%and 20.24%,P<0.05).There was no significant difference in the progression free survival between the two groups(P>0.05).Conclusion In male patients undergoing laparoscopic radical resection of rectal cancer,IMA high ligation and low ligation can achieve similar surgical effects and prognosis,but the latter helps to promote postoperative recovery,reduce the risk of anastomotic leakage,while the former helps to protect the pelvic autonomic nerve.

关 键 词：直肠癌根治术 腹腔镜 肠系膜下动脉 低位结扎 高位结扎 盆腔植物神经 

分 类 号：R735.37[医药卫生—肿瘤]