肠系膜下动脉结扎方案差异对微创直肠癌根治术疗效的影响及第3 站淋巴结转移高危因素分析  

Influence of different kinds of IMA ligation regimens on clinical effect of rectal cancer patients with minimally invasive radical resection and high risk factors of LN metastasis at station 3 analysis

作　　者：皇甫深强[1] 王晓磊[1] 郭伟[1] 李程 王新涛[1] 谢振山 HUANGFU Shenqiang;WANG Xiaolei;GUO Wei;LI Cheng;WANG Xintao;XIE Zhenshan(Department of gastrointestinal surgery,The First Affiliated Hospital of Henan University,Kaifeng,Henan 475001,China)

机构地区：[1]河南大学第一附属医院胃肠外科,河南开封475001

出　　处：《安徽医药》2021年第3期524-528,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨肠系膜下动脉(IMA)结扎方案差异对行微创直肠癌根治术病人疗效的影响及第3站淋巴结转移高危因素分析。方法选取河南大学第一附属医院2014年3月至2017年3月收治行微创直肠癌根治术病人共190例,其中89例术中保留左结肠动脉行IMA低位结扎设为观察组,101例术中不保留左结肠动脉行IMA高位结扎设为对照组;比较两组围手术期临床指标水平、术中术后并发症发生率、术后病理学指标及随访无病生存率,同时对第3站淋巴结转移风险行单因素和多因素分析。结果观察组手术时间为(151.83±26.20)min显著多于对照组的(137.17±22.93)min(P<0.05);观察组术后首次排气时间为(71.80±5.32)h,显著短于对照组的(76.36±6.49)h(P<0.05);两组术中出血量、预防性造瘘率及术后住院时间比较差异无统计学意义(P>0.05);两组术中血管损伤和术后尿潴留发生率比较差异无统计学意义(P>0.05);观察组术后吻合口瘘发生率为5.62%,显著低于对照组的18.81%(P<0.05);两组术后病理学指标和随访无病生存率比较差异无统计学意义(P>0.05);经单因素分析证实,肿瘤部位、肿瘤直径及病理学分型是影响第3站淋巴结转移因素(P<0.05);经多因素分析证实,肿瘤直径>5 cm和病理学分型为非管状腺癌是影响第3站淋巴结转移的独立危险因素(P<0.05)。结论IMA低位结扎方案用于行微创直肠癌根治术病人可获得与高位结扎相近淋巴结清扫效果和无病生存收益,能够有效预防术后吻合口瘘发生,且未增加第3站淋巴结转移风险;同时肿瘤直径>5 cm和病理学分型为非管状腺癌病人术后第3站淋巴结转移风险更高。Objective To investigate the influence of low and high IMA ligation regimens on clinical effect of rectal cancer patients with minimally invasive radical resection and high risk factors of LN metastasis at station 3.Methods A total of 190 rectal cancer pa⁃tients with minimally invasive radical resection in the First Affiliated Hospital of Henan University from March 2014 to March 2017 were selected and divided into two groups including control group(101 patients)with high IMA ligation and observation group(89 pa⁃tients)with low IMA ligation.The perioperative clinical indicators,intraoperative and postoperative complications incidence,postopera⁃tive pathological indicators and disease-free survival rate with follow-up of both groups were compared and univariate and multivariate of LN metastasis risk in station 3 were analyzed.Results The operation time of observation group for(151.83±26.20)min was signifi⁃cant longer than that of control group for(137.17±22.93)min(P<0.05).The postoperative exhaust time for first time of observation group for(71.80±5.32)h were significant shorter than that of control group for(76.36±6.49)h(P<0.05).There was no significant differ⁃ence in the intraoperative bleeding volume,prophylactic fistula rate,hospital staying time after operation,the incidence of intraopera⁃tive vascular injury and postoperative urinary retention between the two groups(P>0.05).The incidence of anastomotic leakage after operation of observation group for 5.62%were significant lower than that of control group for 18.81%(P<0.05).There was no signifi⁃cant difference in the postoperative pathological indicators and disease-free survival rate with follow-up between the two groups(P>0.05).Univariate analysis confirmed that tumor location,tumor diameter and pathological type were the factors affecting LN metastasis at station 3(P<0.05).Multivariate analysis confirmed that tumor diameter>5 cm and non-tubular adenocarcinoma were the indepen⁃dent risk factors for LN metastasis at station 3.Conclusions

关 键 词：直肠镜检查 直肠肿瘤 直肠结肠切除术 重建性 肠系膜下动脉 结扎 疗效 淋巴结转移 

分 类 号：R735.37[医药卫生—肿瘤]