腹腔镜直肠癌前切除术肠系膜下动脉不同结扎平面对患者预后的影响

目的分析腹腔镜直肠癌前切除术中肠系膜下动脉不同结扎平面对患者预后的影响。 方法选取2007年6月至2014年6月间青岛市市立医院收治的行腹腔镜直肠癌前切除术136例患者为研究对象，根据肠系膜下动脉不同的结扎平面，分为保留左结肠动脉的低位结扎组（LL组）76例和不保留左结肠动脉的高位结扎组（HL组）60例。比较两组患者围手术期指标，随访并评价两组的预后。 结果两组手术时间、术中出血量、术后肛门排气时间、淋巴结清扫总数和第253组淋巴结清扫个数差异无统计学意义（t=6.109、4.339、8.386、0.233、0.198，P=0.318、0.416、0.512、0.821、0.669）；LL组术后吻合口瘘的发生率明显低于HL组（χ²=5.186，P=0.029）。HL组术后3、5年总体生存率分别为80.00%和73.33%，LL组分别为77.63%和72.37%，两组比较差异无统计学意义（χ²=1.536、2.156，P=0.863、0.698）。 结论腹腔镜直肠癌前切除术中肠系膜下动脉不同结扎平面可获得相近的淋巴结清扫效果，保留左结肠动脉的低位结扎平面术后吻合口瘘的发生率更低，其他围手术期指标没有差异，联合第三站中央淋巴结清扫值得应用推广。

Prognosis of rectal cancer patients undergoing laparoscopic anterior resection with different ligation planes of inferior mesenteric artery

Objective To analyze the influence of different ligation planes of inferior mesenteric artery on the prognosis of rectal cancer patients undergoing laparoscopic anterior resection.Methods The clinical data of one hundred and thirty-six patients with rectal cancer undergoing anterior resection in Qingdao Municipal Hospital from June 2007 to June 2014 were retrospectively analyzed.According to different levels of inferior mesenteric artery ligation,the patients were divided into two groups.Low ligation group(LL)contained 76 patients with left colonic artery preserved,and high ligation group(HL)contained 60 patients with left colonic artery resected.The perioperative indicators and prognosis of the two groups were evaluated.Results There were no significant differences in operation time,intraoperative bleeding volume,postoperative anal exhaust time,the total number of lymph nodes dissection or the number of No.253 lymph nodes dissection between the two groups(t=6.109,4.339,8.386,0.233,0.198,P=0.318,0.416,0.512,0.821,0.669).Compared with HL group,the incidence of anastomotic leakage in LL group was significantly lower(χ^2=5.186,P=0.029).There were no significant differences between the two groups in the overall 3,5-year survival rates with 80.00%and 73.33%in HL group,and 77.63%and 72.37%in LL group respectively(χ^2=1.536,2.156,P=0.863,0.698).Conclusions There is no difference in the efficacy and prognosis between low ligation of inferior mesenteric artery and high ligation surgery in laparoscopic resection of rectal cancer.Compared with high ligation surgery,the incidence of anastomotic leakage is lower while other perioperative indicators were the same in low ligation surgery.Therefore,low ligation of inferior mesenteric artery with No.3 central lymph node dissection is worth promoting.