摘要目的 探讨肠系膜下动脉(inferior mesenteric artery,IMA)高位结扎与低位结扎保留左结肠动脉(left colic artery,LCA)并血管根部淋巴结清扫对直肠癌手术后并发症的影响与疗效.方法 回顾性分析2015年1月至2016年12月上海交通大学医学院附属瑞金医院外科收治的357例直肠癌患者,其中对IMA行高位结扎组247例,低位结扎组110例.高位结扎组不保留LCA,低位结扎组保留LCA.结果 两组患者的手术时间和术中出血量相比差异均无统计学意义[(105±10) min比(113±9)min,t=0.138,P=0.092;(96±21)ml比(99±23)ml,t=0.171,P=0.118];两组患者的吻合口漏发生率相比差异无统计学意义(7.3％比4.5％,x2=0.949,P=0.330);两组患者的术后低位前切除综合征发生率相比差异有统计学意义(21％比12％,x2=4.358,P=0.037);两组患者的术后病理肿瘤切缘[近端切缘(6.7±3.6)cm比(7.4±3.6)cm,t=1.780,P=0.076;远端切缘(2.0±1.4)cm比(1.8 ±1.3)cm,t=1.331,P=0.184)]和清扫淋巴结总数[(14.5±4.3)个比(13.6±3.5)个,t=1.851,P=0.065]相比差异均无统计学意义.结论 腹腔镜中低位直肠癌切除术中低位结扎IMA,保留LCA能有效保障肠管吻合处血运,降低术后并发症发生率.

abstractsObjective To evaluate the surgical complications and root vascular lymph node dissection by high versus low ligation the inferior mesenteric artery (IMA) retaining left colonic artery (LCA) in laparoscopic radical resection of rectal cancer.Methods Clinical data of 357 cases of rectal cancer in our center from Jan 2015 to Dec 2016,were retrospectively analyzed,including 247 cases in high ligation group,110 cases of low ligation group.Results There was no statistically significant difference in operative time and intraoperative blood loss between the two groups [(105 ± 10)min vs.(113 ±9)min,t =0.138,P =0.092;(96 ± 21) ml vs.(99 ± 23) ml,t =0.171,P =0.118].Nor that in the incidence of anastomotic leakage between the two groups (7.3％ vs.4.5％,x2 =0.949,P =0.330).The incidence of low anterior resection syndrome in the two groups was statistically significant (21％ vs.12％,x2 =4.358,P =0.037).There was no significant difference in the total number of lymph nodes dissected between the two groups ([(14.5±4.3) vs.(13.6±3.5),t=1.851,P=0.065].Conclusion Low ligation of IMA with preservation of LCA in laparoscopic radical operation for rectal cancer provides better blood supply for proximal colon,while achieving same radical clearance of lymph nodes as with high ligation of IMA.