腹腔镜低位直肠癌手术中肠系膜下动脉高位结扎和低位结扎对低位前切除综合征影响研究  

Analysis on influencing factors of postoperative low anterior resection syndrome for rectal cancer patients in low-tie vs high-tie of IMA with laparoscopic lower anterior resection

作　　者：骆洋[1] 何承祥 敬然 杨智岗 俞旻皓[1] 盛春晓 秦绍岚 方洪生 贡婷月 谢荟 钟鸣[1] LUO Yang;HE Cheng-xiang;JING Ran(Department of Gastrointestinal Surgery,Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;不详)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127 [2]上海市普陀区利群医院,上海200060

出　　处：《中国实用外科杂志》2022年第3期320-325,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.81802308,No.81873555);上海市科技创新行动计划西医引导类科技支撑项目(No.19411966200)。

摘　　要：目的分析腹腔镜低位直肠癌前切除术肠系膜下动脉高位结扎和低位结扎对低位前切除综合征(LARS)的影响。方法采用回顾性队列研究方法,收集2019年1月至2020年8月期间在上海交通大学医学院附属仁济医院胃肠外科腹腔镜低位直肠癌前切除术的282例病人的临床资料。根据术中是否保留左结肠动脉(LCA),分为低位结扎组(n=126)和高位结扎组(n=156),比较两组术后LARS发生率和严重程度,并通过单因素和多因素分析LARS的危险因素。结果对126例低位结扎病人术后3个月,6个月和12个月的影像学随访发现,117例(92.86%)病人术后左结肠动脉通畅,仅9例(7.14%)病人术后左结肠动脉闭塞。282例病人术后3个月,6个月,12个月LARS总发生率为:57.44%(162/282),42.91%(121/282),34.04%(96/282);术后3个月后无新发LARS病例。低位结扎组的术后3个月、6个月LARS的发生率明显低于高位结扎组(46.83%vs.66.03%,P=0.00;35.71%vs.48.72%,P=0.03)。而术后12个月低位结扎组和高位结扎组LARS发生率差异无统计学意义(25.40%vs.34.62%,P=0.09)。通过单因素分析,发现肿瘤大小>3.5 cm(P=0.01)、非专业化水平(P=0.01)、高位结扎(P=0.03)、吻合口距齿状线距离≤2 cm(P=0.01)是LARS的危险因素;进一步通过多因素分析,发现高位结扎(P=0.02)、非专业化水平(P=0.01)、吻合口距齿状线距离≤2 cm(P=0.01)是LARS的独立危险因素。结论腹腔镜低位直肠癌前切除术中保留左结肠动脉可以降低术后LARS的发生率,尤其是轻度LARS病人,其近期疗效较满意,有临床推广价值。Objective low-tie and high-tie of the inferior mesenteric artery after laparoscopic low anterior resection.Methods retrospective case-control study was used in this study.Two hundred eighty-two consecutive patients scheduled for laparoscopic surgery for low rectal cancer between January 2019 and August 2020 were classified into two groups,according to whether preservation of Left colic artery(LCA):the low-tie of IMA group(n=126)and the high-tie of IMA group(n=156).The rate of LARS was observed and compared between the groups.And the risk factors of LARS were tested by univariate and multivariate Cox regression analyses.ResultsThe imaging CT showed 117 patients(92.86%)had LCA and only 9 patients(7.14%)without LCA,following up 126 low-tie patients at 3,6 and 12 months.The incidence of LARS was 57.44%(162/282),42.91%(121/282),34.04%(96/282)at 3,6,and 12 months postoperatively,respectively,and no new case of LARS was found after 3 months postoperatively.The rate of LARS in the low-tie group was lower in the high-tie group at 3 and 6 months(6.83%vs.66.03%,P=0.00;35.71%vs.48.72%,P=0.03).While,There was no significant betweenthe low-tie and high-tie about the 12 months LARSrates(25.40%vs.34.62%,P=0.09).Univariateanalysis showed that tumor size>3.5 cm(P=0.03),non-professional surgeon(P=0.00),high-tie of IMA(P=0.00)and anastomotic level from anal verge≤2 cm(P=0.00)were associated with unsatisfied LARS outcomes.Logistic regression analysis showed that high-tie of IMA(P=0.01),on-professional surgeon(P=0.03)and anastomotic level from anal verge≤2 cm(P=0.00)were independent risk factors forLARS outcome.ConclusionThe low-tie of IMA could reduce LARS rate after laparoscopic lower anterior resection ofrectal cancer,especially in patients with mild LARS,which is beneficial to improve the quality of postoperative life ofpatients.

关 键 词：腹腔镜低位直肠癌前切除术 肠系膜下动脉低位结扎 肠系膜下动脉高位结扎 低位前切除综合征 

分 类 号：R6[医药卫生—外科学]