【摘要】 目的 :比较低位结扎肠系膜下动脉(IMA)与高位结扎IMA治疗直肠癌的手术疗效及术后生命质量。方法 :回顾分析2014年1月~2016年1月中国人民解放军总医院及河北承德县医院收治的直肠癌手术患者80例病例资料,根据IMA处理方式不同将以上80例患者分为低位结扎组(n=47)和高位结扎组(n=33)。低位结扎组在左结肠动脉游离出来后进行结扎,然后行淋巴结清扫术,高位结扎组在与腹主动脉起点距离0.5cm以内的肠系膜下动脉根部结扎,然后行淋巴结清扫术。比较两组围手术期相关情况、术后并发症及生命质量。结果 :两组手术时间、术中出血量、总淋巴结清扫数目以及IMA根部淋巴结清扫数目差异无统计学意义,低位结扎组排气时间(35.29±7.52)h,高位结扎组排气时间(44.83±9.63)h,差异具有统计学意义;低位结扎组术后排尿障碍和性功能障碍发生率分别是23.40%和19.15%,高位结扎组术后排尿障碍和性功能障碍发生率分别是6.06%和3.03%,差异有统计学意义;低位结扎组术后整体生命质量评分(73.26±6.84)分,高位结扎组术后整体生命质量评分(78.30±7.25)分,差异有统计学意义。结论 :两种IMA处理方式均可达到直肠癌根治目的,低位结扎IMA后恢复较快,但与高位结扎IMA比较,术后排尿和性功能障碍发生风险较高,术后生命质量较低。更多还原

【Abstract】 Objective To compare the surgical effect and quality of life in patients with rectal cancer treated by low ligation of inferior mesenteric artery(IMA) and high ligation of IMA. Methods The medical records of 80 patients with rectal cancer treated by laparoscopic surgery in The General Hospital of the People’s Liberation Army and Hebei Chengde County Hospital from January 2014 to January 2016 were retrospectively analyzed. According to the different treatment methods of IMA, the patients were divided into low ligation group(n=47) and high ligation group(n=33). Low ligation group were treated with ligation when the left colonic artery was dissociated, and then they were treated with lymph node dissection. High ligation group were treated with ligation of inferior mesenteric artery within 0.5 cm from the starting point of the abdominal aorta and then they were also treated with lymph node dissection. The perioperative condition, postoperative complications and quality of life were compared between the two groups. Results There were no significant differences between the two groups in operation time, intraoperative blood loss, total number of dissected lymph nodes and number of dissected lymph nodes at IMA root. The exhaust time of the low ligation group was(35.29±7.52) h while that of high ligation group was(44.83±9.63) h. The incidence rates of urinary dysfunction and sexual dysfunction in low ligation group after surgery were 23.40% and 19.15% while those in high ligation group were 6.06% and 3.03%, respectively. The overall quality of life scores of the low ligation group and the high ligation group were(73.26±6.84) and(78.30±7.25), respectively. Conclusion Both of the two ligation methods for IMA can cure rectal cancer. However, Patients can recover more quickly after low ligation of IMA. Compared with high ligation of IMA, the risks of urinary and sexual dysfunction are relatively higher and life quality is relatively lower after low ligation of IMA.更多还原