Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy.
Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
Anticancer Res. 2020 May;40(5):2969-2974. doi: 10.21873/anticanres.14276.
Although oncological results for resection of colon cancer with inferior mesenteric artery (IMA) ligation at its origin (high tie) or immediately below the left colic artery (low tie) are similar, injury of the superior hypogastric plexus may be caused when the IMA is tied at its origin, thus impairing defecatory functions.
The importance of IMA tie location on defecatory dysfunction in patients undergoing laparoscopic sigmoidal resection without preoperative radiation therapy was studied.
From February 2013 to December 2018, 56 consecutive patients submitted to curative laparoscopic resection for stage II and III, M0, sigmoidal cancer were randomized to a high or low tie of the IMA. All demographic data and information on symptoms and comorbidity, intra- and post-operative outcomes and defecatory function before and after surgery [according to the following scales: Fecal Incontinence Quality of Life (FIQL) scale, Jorge-Wexner incontinence and Agachan-Wexner constipation scores] were collected into a computerized database.
All patients completed the questionnaires. The educational and social status, and lifestyle habits (defined as active or sedentary) of our groups were similar. A significant difference in total score of FIQL scale was observed between the high and low tie groups at 1 month [88±6 and 93±7, p=0.005, confidence interval for the difference between mean values (CI)=1.706-9.065] and 6 months (93±7 and 97±6, p=0.030, CI=0.390-7.547). The Jorge-Wexner incontinence scores showed a significant decrease in patients of the high group (1 month: 0.59±0.76 and 6 months: 0.62±0.79, respectively) when compared to those of the low tie group (1 month 0.17±0.38 and 6 months 0.17±0.38, respectively) (p=0.008 and p=0.006 at 1 and 6 months, respectively). At 1, 6 and 12 months, the overall Agachan-Wexner constipation scores were significantly higher in patients of the high tie group when compared to those of the low tie group (1 month: 5.1±1.1 and 4.3±0.86, p=0.002, CI=-1.350--0.316; 6 months: 7.4±1.4 and 6.2±1.4, p=0.003, CI=-1.959--0.436; and 12 months: 7.2±1.3 and 6±1.1, p=0.001, CI=-1.840--0.576, respectively).
Patients affected with stage II and III sigmoidal cancer had a better fecal continence at the short- to medium-term and less abdominal pain in the medium- to long-term when a low tie technique was utilized.
虽然结直肠癌根治术中结扎肠系膜下动脉（IMA）在其起源处（高位结扎）或在左结肠动脉下方结扎（低位结扎）的肿瘤学结果相似，但IMA 在其起源处结扎时可能会损伤腹下丛，从而损害排便功能。
研究腹腔镜乙状结肠切除术时IMA 结扎位置对无术前放疗的 II 期和 III 期、M0 乙状结肠癌患者排便功能障碍的重要性。
2013 年 2 月至 2018 年 12 月，56 例连续接受 II 期和 III 期、M0、乙状结肠癌根治性腹腔镜切除术的患者被随机分为IMA 高位结扎组或低位结扎组。收集所有人口统计学数据和症状及合并症信息、围手术期结局以及手术前后的排便功能[根据以下量表：粪便失禁生活质量量表（FIQL）、Jorge-Wexner 失禁评分和 Agachan-Wexner 便秘评分]至计算机数据库中。
所有患者均完成了问卷调查。我们两组的教育和社会地位以及生活方式习惯（定义为活跃或久坐）相似。在术后 1 个月[FIQL 量表总评分：88±6 与 93±7，p=0.005，两组间均值差异的置信区间（CI）=1.706-9.065]和术后 6 个月[FIQL 量表总评分：93±7 与 97±6，p=0.030，CI=0.390-7.547]时，FIQL 量表总分在高位结扎组和低位结扎组之间存在显著差异。与低位结扎组相比，高位结扎组的 Jorge-Wexner 失禁评分在术后 1 个月[0.59±0.76 与 0.62±0.79，p=0.008]和术后 6 个月[0.17±0.38 与 0.17±0.38，p=0.006]时显著降低。在术后 1、6 和 12 个月时，与低位结扎组相比，高位结扎组的整体 Agachan-Wexner 便秘评分在各时间点均显著升高（术后 1 个月：5.1±1.1 与 4.3±0.86，p=0.002，CI=-1.350--0.316；术后 6 个月：7.4±1.4 与 6.2±1.4，p=0.003，CI=-1.959--0.436；术后 12 个月：7.2±1.3 与 6 与 1.1，p=0.001，CI=-1.840--0.576）。
患有 II 期和 III 期乙状结肠癌的患者在中短期时粪便控制更好，在中长期时腹部疼痛更少，当采用低位结扎技术时。
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