天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (4): 411-415.doi: 10.11958/20171373

• 临床研究 • 上一篇    下一篇

低、高位肠系膜下动脉结扎治疗直肠癌的手术疗效及术后 生命质量比较

何俊峰，张明金△，赵成功，李业云，王仕琛，刘鹏，陈尚传   

  1. 作者单位：解放军第105医院普外科（邮编230031） 作者简介：何俊峰（1980），男，本科，主治医师，主要从事胃肠外科、肿瘤外科 △通讯作者 E-mail: zhangmingjin73@yeah.net
  • 收稿日期:2017-12-01 修回日期:2018-01-19 出版日期:2018-04-15 发布日期:2018-04-15
  • 通讯作者: 何俊峰 E-mail:hejunfeng80@126.com

Comparison of surgical effects and postoperative quality of life in patients with rectal cancer treated by low ligation and high ligation of inferior mesenteric artery

HE Jun-feng, ZHANG Ming-jin△, ZHAO Cheng-gong, LI Ye-yun, WANG Shi-chen, LIU Peng, CHEN Shang-chuan   

  1. Department of General Surgery, People’s Liberotion Army No.105 Hospital, Hefei 230031, China △Corresponding Author E-mail: zhangmingjin73@yeah.net
  • Received:2017-12-01 Revised:2018-01-19 Published:2018-04-15 Online:2018-04-15

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摘要： 摘要：目的 比较肠系膜下动脉（IMA）低位结扎与高位结扎治疗直肠癌手术疗效及术后生命质量。方法 94 例直肠癌患者按术中 IMA 结扎方式分为低位组（n=50）与高位组（n=44），比较 2 组手术一般情况、并发症发生率和排 便功能。2 组均完成术后 3 年随访调查，比较 2 组肿瘤转移率、复发率、3 年生存率及欧洲癌症研究与治疗组织 （EORTC）生命质量问卷（QLQ-C30）评分结果。结果 （1）2 组手术时间、术中出血量、淋巴结清扫数目、IMA 根部淋 巴结清扫数目、住院时间比较差异均无统计学意义（P＞0.05），低位组肛门排气时间早于高位组（P＜0.05）。（2）低位 组吻合口瘘发生率低于高位组（P＜0.05），2 组其余各手术并发症发生率比较差异均无统计学意义（P＞0.05）。（3）术 后 3 个月、6 个月及 1 年，2 组排便功能评分均呈上升趋势，低位组术后 3 个月、6 个月、1 年排便功能评分优于高位 组（P＜0.05）。（4）2 组随访 3 年总生存率、肿瘤转移率、复发率比较差异均无统计学意义（P＞0.05）。（5）术后 6 个月、 1 年、2 年、3 年 2 组生命质量评分均呈上升趋势，低位组术后 6 个月生命质量评分高于高位组（P＜0.05）。结论 低 位结扎 IMA 治疗直肠癌手术疗效与高位结扎 IMA 相同，但对患者排便功能影响小，可提升患者近期生命质量。

关键词: 直肠肿瘤, 肠系膜下动脉, 低位结扎, 高位结扎, 根治术

Abstract: Abstract: Objective To compare the surgical effects and quality of life in patients with rectal cancer treated by lower ligation and high ligation of inferior mesenteric artery (IMA). Methods A total of 94 patients with rectal cancer were divid⁃ ed into low ligation group (low ligation of IMA, n=50) and high ligation group (high ligation of IMA, n=44) according to the li⁃ gation mode of IMA. The clinical data, incidence of operative complications and defecation function were compared between the two groups. The two groups of patients were followed up for 3 years after the operation. The tumor metastasis rate, recur⁃ rence rate, 3-year survival rate and scores of European organisation for research and treatment of cancer (EORTC) and quali⁃ ty of life questionnaire (QLQ-C30) were compared between two groups. Results (1)There were no significant differences in operation time, intraoperative blood loss, the number of dissected lymph nodes, the number of dissected IMA root lymph nodes and hospital stay between the two groups (P＞0.05). The anal exhaust time was shorter in low ligation group than that of high ligation group (P＜0.05). (2)The incidence of anastomotic leakage was lower in low ligation group than that of high li⁃ gation group (P＜0.05). There was no significant difference in the incidence of the other operative complications between two groups (P＞0.05). (3)The defecation function scores were increased at 3 months, 6 months and 1 year after operation in two groups (P＜0.05). The defecation function scores were better at 3 months and 6 months after operation in low ligation group than those in high ligation group (P＜0.05). (4)There were no significant differences in the 3-year overall survival rate, tumor metastasis rate and recurrence rate between the two groups (P＞0.05). (5)The quality of life scores were increased at 6 months, 1 year, 2 years and 3 years after operation in two groups (P＜0.05), and the quality of life score at 6 months after op⁃ eration was higher in the low ligation group than that of the high ligation group (P＜0.05). Conclusion The curative effect of low ligation of IMA is similar to that of high ligation of IMA in the treatment of rectal cancer. However, the former has little effect on the defecation function and can improve the short-term quality of life of patients.

Key words: rectal neoplasms, mesenteric artery, inferior, low ligation, high ligation, radical operation