Guo Yuchen, Wang Daguang, He Liang, Zhang Yang, Zhao Shishun, Zhang Luyao, Sun Xuan, Suo Jian
Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, China.
College of Mathematics, Jilin University, Changchun, China.
ANZ J Surg. 2017 Jul;87(7-8):576-581. doi: 10.1111/ans.13032. Epub 2015 Feb 23.
The aim of this clinical trial is to evaluate the influence of high and low ligation of the inferior mesenteric artery with apical lymph node dissection on the anastomotic blood supply, lymph node retrieval rate, operative time and anastomotic leakage rate in rectal cancer surgery.
A total of 57 Chinese patients were randomly distributed into group A and group B and underwent radical resection of rectal cancer. Patients in group A underwent high ligation of the inferior mesenteric artery, and patients in group B underwent apical lymph node resection around the root of the inferior mesenteric artery with preservation of the left colic artery. The marginal artery stump pressure was measured after colon and artery reconstruction. Systemic pressure, distal colon length, operative time and lymph node retrieval rate were measured and recorded. The results were analysed and related to patient characteristics and post-operative complications.
The anastomotic blood supply negatively and linearly correlated with age and distal colon length and showed a positive linear correlation with systemic pressure. Patients who received low ligation with apical lymph node dissection had a better anastomotic blood supply than those who received high ligation. No differences were found in lymph node retrieval rate, operative time and anastomotic leakage rate. Anastomotic leakage was associated with a worse anastomotic blood supply.
Low ligation with apical lymph node dissection in rectal cancer treatment provides better anastomotic blood supply but is not associated with differences in node retrieval rate or operation time.
本临床试验旨在评估直肠癌手术中肠系膜下动脉高位和低位结扎联合顶端淋巴结清扫对吻合口血供、淋巴结清扫率、手术时间及吻合口漏发生率的影响。
57例中国患者被随机分为A组和B组，均接受直肠癌根治性切除术。A组患者行肠系膜下动脉高位结扎，B组患者行肠系膜下动脉根部周围顶端淋巴结清扫并保留左结肠动脉。结肠与动脉重建后测量边缘动脉残端压力。测量并记录全身血压、远端结肠长度、手术时间及淋巴结清扫率。对结果进行分析，并与患者特征及术后并发症相关联。
吻合口血供与年龄及远端结肠长度呈负线性相关，与全身血压呈正线性相关。接受低位结扎联合顶端淋巴结清扫的患者吻合口血供优于接受高位结扎的患者。淋巴结清扫率、手术时间及吻合口漏发生率未见差异。吻合口漏与较差的吻合口血供相关。
直肠癌治疗中低位结扎联合顶端淋巴结清扫可提供更好的吻合口血供，但与淋巴结清扫率或手术时间差异无关。
