中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
Chinese Journal of Gastrointestinal Surgery
2015年
11期
1132-1135
,共4页
王庆广%张彩坤%张豪英%王燕红%袁正强%翟超
王慶廣%張綵坤%張豪英%王燕紅%袁正彊%翟超
왕경엄%장채곤%장호영%왕연홍%원정강%적초
直肠肿瘤%低位前切除术%肠系膜下动脉%高位结扎%低位结扎%排粪功能
直腸腫瘤%低位前切除術%腸繫膜下動脈%高位結扎%低位結扎%排糞功能
직장종류%저위전절제술%장계막하동맥%고위결찰%저위결찰%배분공능
Rectal neoplasms%Anterior resection%Inferior mesenteric artery%High ligation%Low ligation%Bowel function
目的 探讨低位前切除术中不同肠系膜下动脉(IMA)结扎水平对直肠癌患者术后排粪功能的影响.方法 前瞻性纳入2012年1月1日至2013年12月31日期间山东省淄博市第一医院收治并拟行低位前切除术的128例直肠癌患者,随机分至IMA高位结扎组(63例,距IMA根部1.0～1.5 cm切断)和低位结扎组(65例,距IMA发出的左结肠动脉根部0.5～1.0 cm切断),观察两组患者术后3月和1年的排粪功能情况及其他术后疗效.结果 高位结扎组与低位结扎组术中清扫淋巴结数目差异无统计学意义[8(1～30)枚/例比7(2～28)枚/例,P=0.125];但高位结扎组转移性淋巴结数目更多[1(0～9)枚/例比0(0～8)枚/例,P=0.041].术后3月,高位结扎组平均排粪次数明显多于低位结扎组[5(2～10)次/d比3(1～8)次/d,P=0.035],而其他排粪功能评价指标的差异均无统计学意义(均P＞0.05).术后1年,高位结扎组需要使用泻剂的患者比例高于低位结扎组[6例(11.3％,6/53)比1例(1.7％,1/58),P=0.038],而其他排粪功能评价指标的差异均无统计学意义(均P＞0.05).术后随访1年,高位结扎组和低位结扎组分别有3例(5.7％,3/53)和2例(3.4％,2/58)患者出现肿瘤复发,差异无统计学意义(P=0.623).结论 低位前切除术中低位结扎IMA有助于保护患者的排粪功能.
目的 探討低位前切除術中不同腸繫膜下動脈(IMA)結扎水平對直腸癌患者術後排糞功能的影響.方法 前瞻性納入2012年1月1日至2013年12月31日期間山東省淄博市第一醫院收治併擬行低位前切除術的128例直腸癌患者,隨機分至IMA高位結扎組(63例,距IMA根部1.0～1.5 cm切斷)和低位結扎組(65例,距IMA髮齣的左結腸動脈根部0.5～1.0 cm切斷),觀察兩組患者術後3月和1年的排糞功能情況及其他術後療效.結果 高位結扎組與低位結扎組術中清掃淋巴結數目差異無統計學意義[8(1～30)枚/例比7(2～28)枚/例,P=0.125];但高位結扎組轉移性淋巴結數目更多[1(0～9)枚/例比0(0～8)枚/例,P=0.041].術後3月,高位結扎組平均排糞次數明顯多于低位結扎組[5(2～10)次/d比3(1～8)次/d,P=0.035],而其他排糞功能評價指標的差異均無統計學意義(均P＞0.05).術後1年,高位結扎組需要使用瀉劑的患者比例高于低位結扎組[6例(11.3％,6/53)比1例(1.7％,1/58),P=0.038],而其他排糞功能評價指標的差異均無統計學意義(均P＞0.05).術後隨訪1年,高位結扎組和低位結扎組分彆有3例(5.7％,3/53)和2例(3.4％,2/58)患者齣現腫瘤複髮,差異無統計學意義(P=0.623).結論 低位前切除術中低位結扎IMA有助于保護患者的排糞功能.
목적 탐토저위전절제술중불동장계막하동맥(IMA)결찰수평대직장암환자술후배분공능적영향.방법 전첨성납입2012년1월1일지2013년12월31일기간산동성치박시제일의원수치병의행저위전절제술적128례직장암환자,수궤분지IMA고위결찰조(63례,거IMA근부1.0～1.5 cm절단)화저위결찰조(65례,거IMA발출적좌결장동맥근부0.5～1.0 cm절단),관찰량조환자술후3월화1년적배분공능정황급기타술후료효.결과 고위결찰조여저위결찰조술중청소림파결수목차이무통계학의의[8(1～30)매/례비7(2～28)매/례,P=0.125];단고위결찰조전이성림파결수목경다[1(0～9)매/례비0(0～8)매/례,P=0.041].술후3월,고위결찰조평균배분차수명현다우저위결찰조[5(2～10)차/d비3(1～8)차/d,P=0.035],이기타배분공능평개지표적차이균무통계학의의(균P＞0.05).술후1년,고위결찰조수요사용사제적환자비례고우저위결찰조[6례(11.3％,6/53)비1례(1.7％,1/58),P=0.038],이기타배분공능평개지표적차이균무통계학의의(균P＞0.05).술후수방1년,고위결찰조화저위결찰조분별유3례(5.7％,3/53)화2례(3.4％,2/58)환자출현종류복발,차이무통계학의의(P=0.623).결론 저위전절제술중저위결찰IMA유조우보호환자적배분공능.
Objective To investigate the effect of ligation level of inferior mesenteric artery (IMA) on postoperative defecation function in patients with rectal cancer.Methods A total of 128 rectal cancer patients who were planned to undergo low anterior resection in the First Hospital of Zibo City between January 1, 2012 and December 31, 2013 were prospectively enrolled and randomly divided into IMA high ligation group (63 cases, cutting distance of 1.0 to 1.5 cm to the root of IMA) and low ligation group (65 cases, cutting distance of 0.5 to 1.0 cm to the root of left colic artery originated from IMA).The efficacy, especially the defecation function, was observed and compared 3 months and 1 year after surgery between the two groups.Results No significant difference was found in the number of harvested lymph nodes between two groups[8(1-30) vs.7(2-28), P=0.125], but high ligation group had greater number of metastatic lymph nodes[1 (0-9) vs.0(0-8), P=0.041].Frequency of defecation in high ligation group was significantly higher than that in low ligation group during postoperative 3-month follow-up[5(2-10)/d vs.3(1-8)/d, P=0.035], whereas other indexes of defecation function were not significantly different (all P＞0.05).The proportion of patients needing laxatives in high ligation group was higher than that in low ligation group during postoperative 1-year follow-up [11.3％(6/53) vs.1.7％(1/58), P=0.038], whereas other indexes of defecation function were not significantly different as well (all P＞0.05).Three cases and 2 cases showed recurrence in high ligation group and low ligation group respectively during postoperative 1-year follow-up without significant difference (P=0.623).Conclusion Low ligation of IMA in low anterior resection for rectal cancer is beneficial to the protection against defecation function.
