CT精准引导下高或低位肠系膜下动脉结扎在腹腔镜直肠前切除术中的效果比较  

Comparison of high or low inferior mesenteric artery ligation in laparoscopic anterior resection of rectum based on CT precise guidance

作　　者：张海清[1] 张光军[1] 单远洲[1] 黄忠明[1] 杨治[1] 周联明[1] Zhang Haiqing;Zhang Guangjun;Shan Yuanzhou;Huang Zhongming;Yang Zhi;Zhou Lianming(Department of General Surgery,Shanghai Sixth People′s Hospital South Campus,Shanghai Fengxian Central Hospital,Shanghai 201499,China)

机构地区：[1]上海市第六人民医院南院(上海市奉贤区中心医院)普外科,201499

出　　处：《中国医师进修杂志》2021年第11期1010-1014,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的比较CT精准引导下高或低位肠系膜下动脉(IMA)结扎在腹腔镜直肠前切除术中的效果。方法选取2016年1月于2020年6月上海市第六人民医院南院限期行腹腔镜直肠前切除术治疗的直肠癌患者120例。根据自愿原则选择手术方案,其中行高位IMA结扎68例(高位结扎组),行低位IMA结扎52例(低位结扎组)。记录两组围手术期情况(手术时间、术中出血量、术后肛门排气时间、腹腔引流量、住院时间和回肠造瘘情况)、术后病理资料(近端切缘距离、远端切缘距离、淋巴结清扫总数和阳性淋巴结数)、术后恢复情况(吻合口瘘、尿潴留、性功能障碍和每天排便次数)。术后6个月采用结直肠癌专用生命质量量表(QLQ-CR38)评价患者生命质量。患者术后随访6~36个月,记录局部复发和远处转移情况。结果低位结扎组术后肛门排气时间明显短于高位结扎组[(2.87±1.04)d比(3.26±1.00)d],差异有统计学意义(P<0.05);两组手术时间、术中出血量、腹腔引流量、住院时间和回肠造瘘率比较差异无统计学意义(P>0.05)。两组近端切缘距离、远端切缘距离、淋巴结清扫总数和阳性淋巴结数比较差异无统计学意义(P>0.05)。低位结扎组吻合口瘘、尿潴留和性功能障碍发生率明显低于高位结扎组[3.85%(2/52)比13.24%(9/68)、3.85%(2/52)比11.76%(8/68)和5.77%(3/52)比14.71%(10/68)],每天排便次数明显少于高位结扎组[(2.87±0.98)次比(4.05±1.56)次],差异有统计学意义(P<0.05或<0.01)。低位结扎组术后QLQ-CR38功能维度、症状维度和总分均明显高于高位结扎组[(15.46±4.22)分比(13.68±3.56)分、(51.82±13.54)分比(45.65±12.42)分和(67.28±14.28)分比(59.33±12.85)分],差异有统计学意义(P<0.05或<0.01)。两组局部复发率和远处转移率比较差异无统计学意义(P>0.05)。结论腹腔镜直肠前切除术中采用CT精准引导下低位IMA结扎可获得与高位IMA结扎相同的手术效果,可�Objective To compare the advantages of high or low inferior mesenteric artery(IMA)ligation in laparoscopic anterior resection of rectum based on CT precise guidance.Methods One hundred and twenty patients with rectal cancer who underwent laparoscopic anterior resection of rectum in Shanghai Sixth People′s Hospital South Campus from January 2016 to June 2020 were selected.Surgical protocol was selected according to the principle of voluntariness.Sixty-eight cases underwent high IMA ligation(high IMA ligation group),and 52 cases underwent low IMA ligation(low IMA ligation group).The perioperative conditions(operative time,intraoperative blood loss,postoperative anal exhaust time,abdominal drainage,hospitalization time and ileostomy),postoperative pathological data(proximal margin distance,distal margin distance,total number of dissected lymph nodes and number of positive lymph nodes)and postoperative recovery(anastomotic stoma fistula,urinary retention,sexual dysfunction and daily number of defecation)were recorded.The quality of life 6 months after surgery was evaluated by the quality of life instruments for colorectal cancer scale(QLQ-CR38).Patients were followed up for 6 to 36 months,and the local recurrence and distant metastasis were recorded.Results The postoperative anal exhaust time in low IMA ligation group was significantly shorter than that in high IMA ligation group:(2.87±1.04)d vs.(3.26±1.00)d,and there was statistical difference(P<0.05);there were no statistical differences in operative time,intraoperative blood loss,abdominal drainage,hospitalization time and rate of ileostomy between 2 groups(P>0.05).There were no statistical difference in proximal margin distance,distal margin distance,total number of dissected lymph nodes and number of positive lymph nodes between 2 groups(P>0.05).The incidences of anastomotic stoma fistula,urinary retention and sexual dysfunction in low IMA ligation group were significantly lower than those in high ligation group:3.85%(2/52)vs.13.24%(9/68),3.85%(2/52)vs.11.76

关 键 词：直肠肿瘤 体层摄影术 X线计算机 腹腔镜 肠系膜动脉 

分 类 号：R730.44[医药卫生—肿瘤] R735.37[医药卫生—临床医学]