Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
Neurogastroenterol Motil. 2009 Dec;21(12):1288-e123. doi: 10.1111/j.1365-2982.2009.01331.x. Epub 2009 Jun 5.
Ligation of the inferior mesenteric artery (IMA) during sigmoid colectomy may cause sympathetic denervation of the rectal stump. The purpose of our study was to investigate the functional results after sigmoid resection following ligation or preservation of the IMA. We prospectively analysed 44 patients (21 female and 23 male, mean age 60.6 +/- 11.79 years) with sigmoid tumour. Sigmoid colectomy with preservation of the IMA was performed in 21 patients, and ligation of the IMA with sigmoidectomy was carried out in 23 patients. Bowel function follow-up was performed by use of questionnaires: standardized functional questionnaire, constipation-specific, and incontinence scales before, 6 and 12 months after surgery. The quality of life was measured by means of the Fecal Incontinence Quality of Life (FIQL) scale. After sigmoid colectomy with division of the IMA, patients presented with a higher rate of fecal incontinence and increased stool frequency compared with patients after sigmoid resection with preservation of the IMA. Deterioration of FIQL was also observed in patients with ligated IMA. Preservation of the IMA during sigmoid colectomy in selected patients lowers the frequency of postoperative impaired anorectal function.
在乙状结肠切除术时结扎肠系膜下动脉（IMA）可能导致直肠残端的交感神经去神经支配。我们的研究目的是调查IMA 结扎或保留后行乙状结肠切除术的功能结果。我们前瞻性分析了 44 例乙状结肠肿瘤患者（21 名女性和 23 名男性，平均年龄 60.6 +/- 11.79 岁）。21 例患者行保留 IMA 的乙状结肠切除术，23 例患者行结扎 IMA 并同时行乙状结肠切除术。通过问卷对肠道功能进行随访：术前、术后 6 个月和 12 个月进行标准化功能问卷、便秘特异性和失禁量表评估。通过粪便失禁生活质量（FIQL）量表评估生活质量。与保留IMA 的乙状结肠切除术患者相比，IMA 切断后的乙状结肠切除术患者更易出现粪便失禁和粪便频率增加。IMA 结扎的患者 FIQL 也有恶化。在选择的患者中，在乙状结肠切除术中保留IMA 可降低术后肛门直肠功能障碍的发生率。
