Zhou Jiaming, Zhang Shuyun, Huang Jun, Huang Pinzhu, Peng Shaoyong, Lin Jinxin, Li Tuoyang, Wang Jianping, Huang Meijin
Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Jan 25;21(1):46-52.
To explore the feasibility and clinical significance of precision low inferior mesenteric artery (IMA) ligation with the left colonic artery (LCA) preservation and root lymph node dissection in laparoscopic radical resection for rectal cancer, according to the inferior mesenteric artery (IMA) types.
One Hundred and fore cases of rectal cancer patients who underwent laparoscopic resection in The Sixth Affiliated Hospital of Sun Yat-sen University from October 2015 to June 2016 were selected and divided into study group and control group according to different surgical methods. The study group (52 cases) accepted precision low IMA ligation with the LCA preservation and root lymph node (No.253) dissection, according to the IMA types and length examined by preoperative computed tomography angiography (CTA) reconstruction. The control group (52 cases) accepted the traditional high IMA ligation. The perioperative efficacy indexes and postoperative recovery situation of the two groups were compared.
The IMA types, IMA length and preoperative clinical stages were not significantly different between the two groups (all P>0.05). The surgery was completed smoothly for patients in both groups, with no conversion to open surgery. But two patients in the study group underwent left colonic artery ligation for intra-operative need. There were no significant differences in the operative time, intra-operative blood lose, the rate of protective ileostomy and post-operative pathological stages between the two groups (all P>0.05). More total lymph nodes [(24.9±5.7) vs. (16.9±4.2), P=0.001] and No.253 lymph nodes [(2.4±1.1) vs. (1.5±0.8), P=0.001] were harvested in study group as compared to control group. However, the positive rate of total harvested lymph nodes and No.253 lymph nodes between the two groups were not significantly different (P>0.05). There were no significant differences between the two groups in postoperative first anal exhaust time, postoperative hospital stay, total volume of postoperative intraperitoneal drainage, postoperative abdominal drainage tube retention time, postoperative anal drainage tube retention time and postoperative catheter retention time (All P>0.05). There were 2 cases of postoperative dysuria and 1 case of anastomotic bleeding in study group. There were 3 cases of postoperative dysuria and 2 cases of anastomotic leak in control group. Less postoperative complications (5.8% vs. 9.6%, P<0.05) in study group as compared to control group. There was no rehospitalization or death case in two groups within 30 days after operation.
In the laparoscopic radical resection of rectal cancer, preserving LCA and cleaning the root lymph nodes according to IMA types, which could increase the number of harvested lymph nodes and reduce the postoperative complications was safe and effective.
根据肠系膜下动脉（IMA）分型，探讨精准低位结扎肠系膜下动脉并保留左结肠动脉（LCA）及根部淋巴结清扫在腹腔镜直肠癌根治术中的可行性及临床意义。
选取2015年10月至2016年6月在中山大学附属第六医院行腹腔镜切除术的104例直肠癌患者，根据不同手术方式分为研究组和对照组。研究组（52例）根据术前计算机断层血管造影（CTA）重建检查的IMA分型及长度，接受精准低位IMA结扎并保留LCA及根部（第253组）淋巴结清扫。对照组（52例）接受传统高位IMA结扎。比较两组围手术期疗效指标及术后恢复情况。
两组间IMA分型、IMA长度及术前临床分期差异均无统计学意义（均P>0.05）。两组患者手术均顺利完成，无中转开腹。但研究组有2例患者术中因需要行左结肠动脉结扎。两组间手术时间、术中出血量、保护性回肠造口率及术后病理分期差异均无统计学意义（均P>0.05）。与对照组相比，研究组收获的总淋巴结数[（24.9±5.7）枚 vs.（16.9±4.2）枚，P=0.001]及第253组淋巴结数[（2.4±1.1）枚 vs.（1.5±0.8）枚，P=0.001]更多。然而，两组收获的总淋巴结及第253组淋巴结阳性率差异无统计学意义（P>0.05）。两组术后首次肛门排气时间、术后住院时间、术后腹腔引流量、术后腹腔引流管留置时间、术后肛门引流管留置时间及术后尿管留置时间差异均无统计学意义（均P>0.05）。研究组术后出现2例排尿困难及1例吻合口出血。对照组术后出现3例排尿困难及2例吻合口漏。研究组术后并发症少于对照组（5.8% vs. 9.6%，P<0.05）。两组术后30天内均无再次住院或死亡病例。
在腹腔镜直肠癌根治术中，根据IMA分型保留LCA并清扫根部淋巴结，可增加淋巴结收获数量并减少术后并发症，安全有效。
