低位结扎肠系膜下动脉在非Ⅰ型乙状结肠系膜腹腔镜Dixon术中的临床意义
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摘要
目的探讨低位结扎肠系膜下动脉(IMA)在非Ⅰ型乙状结肠系膜(SMC)腹腔镜Dixon术中的应用价值。方法将2017年9月—2018年7月我院胃肠外科收治的71例非Ⅰ型乙状结肠系膜直肠癌患者随机分为两组,即保留左结肠动脉组(低位结扎组)和不保留左结肠动脉组(高位结扎组)。所有患者均行肠系膜下动脉三维重建显影,以指导术中血管精准结扎。比较两组患者一般临床资料、术中及术后量化统计指标。结果术中3例保留左结肠动脉患者因无法满足吻合被迫转为高位结扎。两组手术时间[170(160,180)vs. 180(170,210)]差异有统计学意义(P=0.026),但两组间性别、年龄、BMI、肿瘤距肛缘距离、TNM分期、术中出血量、脾曲游离率预防造口率、标本长度、瘤体最大径、组织类型、淋巴结清扫总数、D3组淋巴结清扫数目、首次通气时间、术后留院时间及吻合口漏发生率的比较,差异均无统计学意义(P>0.05)。结论低位结扎能缩短手术时间并显著减少非计划切除的肠管长度及降低术后吻合口漏发生的风险,有利于患者术后的恢复,具有重要的临床指导价值。
Objective To explore the application value of low ligation of inferior mesenteric artery(IMA)in laparoscopic Dixon of nonⅠsigmoid colon mesangial(SMC).Methods Seventy-one cases of nonⅠSMC rectal cancer patients who evaluated for feasibility of laparoscopic Dixon in the Department of Gastrointestinal Surgery Affiliated Tumor Hospital of Xinjiang Medical University from September 2017 to July 2018 were selected in this study,and they were randomly divided into two groups:the group of left colic artery reserved(low ligation group)and the group of left colic artery not retained(high ligation group).A three-dimensional computed tomography angiography of inferior mesenteric artery was obtained in all patients to guide the intraoperative accurate ligation of vessels.The baseline data,intraoperative and postoperative quantitative parameters of the two groups were compared.Results Three patients in the group of left colic artery reserved were forced to turn to high ligation for it could not meet the requirement of anastomosis.The low ligation group showed significant difference to the high ligation group on operation time[170(160,180)vs.180(170,210)](P=0.026),but there was no significant difference in the aspect of gender,age,BMI,distance between tumor and anal border,TNM stage,intraoperative blood loss,the splenic free rate,prophylactic stoma rate,Length of specimen,maximum diameter of tumor,tissue typing,total lymph node count,D3 lymph node count,postoperative first exhaust time,days in hospital since surgery and anastomotic fistula rate(P>0.05).Conclusion Low ligation of inferior mesenteric artery can shorten the operation time and significantly lessen unplanned bowel length and reduce postoperative risk of anastomotic leakage.All of these are beneficial to patients′ postoperative recovery and have important clinical guiding value.
Objective To explore the application value of low ligation of inferior mesenteric artery(IMA)in laparoscopic Dixon of nonⅠsigmoid colon mesangial(SMC).Methods Seventy-one cases of nonⅠSMC rectal cancer patients who evaluated for feasibility of laparoscopic Dixon in the Department of Gastrointestinal Surgery Affiliated Tumor Hospital of Xinjiang Medical University from September 2017 to July 2018 were selected in this study,and they were randomly divided into two groups:the group of left colic artery reserved(low ligation group)and the group of left colic artery not retained(high ligation group).A three-dimensional computed tomography angiography of inferior mesenteric artery was obtained in all patients to guide the intraoperative accurate ligation of vessels.The baseline data,intraoperative and postoperative quantitative parameters of the two groups were compared.Results Three patients in the group of left colic artery reserved were forced to turn to high ligation for it could not meet the requirement of anastomosis.The low ligation group showed significant difference to the high ligation group on operation time[170(160,180)vs.180(170,210)](P=0.026),but there was no significant difference in the aspect of gender,age,BMI,distance between tumor and anal border,TNM stage,intraoperative blood loss,the splenic free rate,prophylactic stoma rate,Length of specimen,maximum diameter of tumor,tissue typing,total lymph node count,D3 lymph node count,postoperative first exhaust time,days in hospital since surgery and anastomotic fistula rate(P>0.05).Conclusion Low ligation of inferior mesenteric artery can shorten the operation time and significantly lessen unplanned bowel length and reduce postoperative risk of anastomotic leakage.All of these are beneficial to patients′ postoperative recovery and have important clinical guiding value.
引文
1 Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
2 向国卿,赵莹,朱佳,等.9769例结直肠癌的构成特征及变化趋势[J].现代肿瘤医学,2016,24(20):3236-3239.
3 Dayal S,Battersby N,Cecil T.Evolution of surgical treatment for rectal cancer:a review[J].J Gastrointest Surg,2017,21(7):1166-1173.
4 韩广森,王刚成,任莹坤,等.乙状结肠系膜分型直肠癌手术中的意义[J].医药论坛杂志,2011(11):93-95.
5 韩广森,赵玉洲,李智,等.乙状结肠系膜粘连类型在低位直肠癌前切除手术中的临床意义[J].中国当代医药,2011,18(7):11-13.
6 杜燕夫,渠浩.肠系膜下动脉不同的分支和变异在直肠癌根治术中的临床意义[J].中华结直肠疾病电子杂志,2015,4(5):20-22.
7 臧潞,马君俊,郑民华.直肠癌根治术中保留左结肠动脉对吻合口瘘及手术时间的影响[J].中华胃肠外科杂志,2016,19(4):386-387.
8 秦长江,宋新明.肠系膜下动脉的高位结扎[J].中华胃肠外科杂志,2016,19(8):884-885.
9 Miyamoto R,Nagai K,Kemmochi A,et al.Three-dimensional reconstruction of the vascular arrangement including the inferior mesenteric artery and left colic artery in laparoscope-assisted colorectal surgery[J].Surg Endosc,2016,30(10):1-5.
10 Yang Y,Wang G,He J,et al.High tie versus low tie of the inferior mesenteric artery in colorectal cancer:a meta-analysis[J].Int J Surg,2018,52:20-24.
11 Guraya SY.Optimum level of inferior mesenteric artery ligation for the left-sided colorectal cancer.Systematic review for high and low ligation continuum[J].Saudi Med J,2016,37(7):731-736.
12 Charan I,Kapoor A,Singhal MK,et al.High ligation of inferior mesenteric artery in left colonic and rectal cancers:lymph node yield and survival benefit[J].Indian J Surg,2015,77(Suppl 3):1103-1108.
13 Mari G,Maggioni D,Costanzi A,et al.“High or low inferior mesenteric artery ligation in laparoscopic low anterior resection:study protocol for a randomized controlled trial”(HIGHLOW trial)[J].Trials,2015,16:21-25.
14 Matsuda K,Yokoyama S,Hotta T,et al.Oncological outcomes following rectal cancer surgery with high or low ligation of the inferior mesenteric artery[J].Gastrointest Tumors,2017,4(1/2):45-52.
15 Elkased A,Elgammal A,Ammar M,et al.Apical lymph node dissection and low ligation of inferior mesenteric artery in the management of distal colorectal cancer[J].Egyptian J Surgery,2016,35(3):298-304.
16 Komen N,Slieker J,Kort PD,et al.High tie versus low tie in rectal surgery:comparison of anastomotic perfusion[J].Int J Colorectal Dis,2011,26(8):1075-1078.
17 李心翔,李清国.腹腔镜直肠癌术中左结肠动脉低位结扎的意义[J].中华胃肠外科杂志,2018,21(3).272-275.
18 周家铭,谭淑云,黄俊,等.根据肠系膜下动脉各分支分型行精准低位结扎并根部淋巴结清扫的腹腔镜直肠癌根治术[J].中华胃肠外科杂志,2018,21(1):46-52.
19 Junichiro T,Takeshi N,Toshiaki T,et al.Analysis of anastomotic leakage after rectal surgery:a case-control study[J].Ann Med Surg(Lond),2015,4(2):183-186.
20 张展志,肖萌萌,李雁,等.腹腔镜直肠癌保肛手术后吻合口瘘的危险因素与对策[J].中华肿瘤防治杂志,2016,23(1):40-44.
2 向国卿,赵莹,朱佳,等.9769例结直肠癌的构成特征及变化趋势[J].现代肿瘤医学,2016,24(20):3236-3239.
3 Dayal S,Battersby N,Cecil T.Evolution of surgical treatment for rectal cancer:a review[J].J Gastrointest Surg,2017,21(7):1166-1173.
4 韩广森,王刚成,任莹坤,等.乙状结肠系膜分型直肠癌手术中的意义[J].医药论坛杂志,2011(11):93-95.
5 韩广森,赵玉洲,李智,等.乙状结肠系膜粘连类型在低位直肠癌前切除手术中的临床意义[J].中国当代医药,2011,18(7):11-13.
6 杜燕夫,渠浩.肠系膜下动脉不同的分支和变异在直肠癌根治术中的临床意义[J].中华结直肠疾病电子杂志,2015,4(5):20-22.
7 臧潞,马君俊,郑民华.直肠癌根治术中保留左结肠动脉对吻合口瘘及手术时间的影响[J].中华胃肠外科杂志,2016,19(4):386-387.
8 秦长江,宋新明.肠系膜下动脉的高位结扎[J].中华胃肠外科杂志,2016,19(8):884-885.
9 Miyamoto R,Nagai K,Kemmochi A,et al.Three-dimensional reconstruction of the vascular arrangement including the inferior mesenteric artery and left colic artery in laparoscope-assisted colorectal surgery[J].Surg Endosc,2016,30(10):1-5.
10 Yang Y,Wang G,He J,et al.High tie versus low tie of the inferior mesenteric artery in colorectal cancer:a meta-analysis[J].Int J Surg,2018,52:20-24.
11 Guraya SY.Optimum level of inferior mesenteric artery ligation for the left-sided colorectal cancer.Systematic review for high and low ligation continuum[J].Saudi Med J,2016,37(7):731-736.
12 Charan I,Kapoor A,Singhal MK,et al.High ligation of inferior mesenteric artery in left colonic and rectal cancers:lymph node yield and survival benefit[J].Indian J Surg,2015,77(Suppl 3):1103-1108.
13 Mari G,Maggioni D,Costanzi A,et al.“High or low inferior mesenteric artery ligation in laparoscopic low anterior resection:study protocol for a randomized controlled trial”(HIGHLOW trial)[J].Trials,2015,16:21-25.
14 Matsuda K,Yokoyama S,Hotta T,et al.Oncological outcomes following rectal cancer surgery with high or low ligation of the inferior mesenteric artery[J].Gastrointest Tumors,2017,4(1/2):45-52.
15 Elkased A,Elgammal A,Ammar M,et al.Apical lymph node dissection and low ligation of inferior mesenteric artery in the management of distal colorectal cancer[J].Egyptian J Surgery,2016,35(3):298-304.
16 Komen N,Slieker J,Kort PD,et al.High tie versus low tie in rectal surgery:comparison of anastomotic perfusion[J].Int J Colorectal Dis,2011,26(8):1075-1078.
17 李心翔,李清国.腹腔镜直肠癌术中左结肠动脉低位结扎的意义[J].中华胃肠外科杂志,2018,21(3).272-275.
18 周家铭,谭淑云,黄俊,等.根据肠系膜下动脉各分支分型行精准低位结扎并根部淋巴结清扫的腹腔镜直肠癌根治术[J].中华胃肠外科杂志,2018,21(1):46-52.
19 Junichiro T,Takeshi N,Toshiaki T,et al.Analysis of anastomotic leakage after rectal surgery:a case-control study[J].Ann Med Surg(Lond),2015,4(2):183-186.
20 张展志,肖萌萌,李雁,等.腹腔镜直肠癌保肛手术后吻合口瘘的危险因素与对策[J].中华肿瘤防治杂志,2016,23(1):40-44.