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中华普外科手术学杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 334 -337. doi: 10.3877/cma.j.issn.1674-3946.2024.03.026

论著

不同肠系膜下动脉分型的腹腔镜低位直肠前切除术临床效果及经验总结
赵国栋1, 陆锦俊1, 许永强2,()   
  1. 1. 226100 江苏南通,南通市海门区人民医院普外科
    2. 226100 江苏南通,南通市海门区人民医院血管外科
  • 收稿日期:2023-08-30 出版日期:2024-06-26
  • 通信作者: 许永强

Clinical effect and experience summary of laparoscopic low anterior rectal resection with different submesenteric artery types

Guodong Zhao1, Jinjun Lu1, Yongqiang Xu2,()   

  1. 1. Department of General Surgery, Nantong Haimen District People’s Hospital, Nantong Jiangsu Province 226100, China
    2. Department of Vascular Surgery, Nantong Haimen District People’s Hospital, Nantong Jiangsu Province 226100, China
  • Received:2023-08-30 Published:2024-06-26
  • Corresponding author: Yongqiang Xu
引用本文:

赵国栋, 陆锦俊, 许永强. 不同肠系膜下动脉分型的腹腔镜低位直肠前切除术临床效果及经验总结[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 334-337.

Guodong Zhao, Jinjun Lu, Yongqiang Xu. Clinical effect and experience summary of laparoscopic low anterior rectal resection with different submesenteric artery types[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(03): 334-337.

目的

分析肠系膜下动脉(IMA)分型在腹腔镜低位直肠前切除术中的临床价值。

方法

回顾性选取2019年5月至2022年5月接受腹腔镜低位直肠前切除术的患者107例,根据术前血管三维重建结果用Murono分型方法将IMA分为Ⅰ型组(n=43)、Ⅱ型组(n=24)、Ⅲ型组(n=28)、Ⅳ型组(n=12)。用SPSS 22.0分析数据。并发症等计数资料用[例(%)]表示,多组间比较用χ2检验或Fisher精确概率法,等级计数资料用非参数秩和检验;围手术期指标等计量资料用()表示,多组间比较用F检验。P<0.05为差异有统计学意义。

结果

不同IMA分型的LIMA、DIMA比较差异无统计学意义(P>0.05)。107例患者中Ⅰ型、Ⅱ型、Ⅲ型术中均行IMA低位结扎,Ⅳ型行IMA高位结扎。Ⅳ型组患者术后首次排气时间显著长于Ⅰ型、Ⅱ型、Ⅲ型组(P<0.05);Ⅳ型组患者吻合口漏、排便困难发生率及并发症总发生率显著高于Ⅰ-Ⅲ型组(P<0.05)。

结论

术前进行血管三维重建了解IMA分型,明确IMA至左结肠动脉(LCA)和腹主动脉的距离,从而选择最合适的IMA结扎方式,减少盲目手术所致的副损伤风险,更利于达到精准化保留LCA的目的,对促进患者肠道功能恢复及降低吻合口漏发生率具有积极作用。

Objective

To analyze the clinical value of submesenteric artery (IMA) classification in laparoscopic low anterior rectal resection.

Methods

A total of 107 patients who underwent laparoscopic low anterior rectal resection from May 2019 to May 2022 were retrospectively selected. IMA was divided into type Ⅰ group (n=43), type Ⅱ group (n=24), type Ⅲ group (n=28) and type Ⅳ group (n=12) according to the results of preoperative three-dimensional vascular reconstruction by Murono classification method. SPSS 22.0 was used to analyze the data. Count data such as complications were represented by [cases (%)], χ2 test or Fisher exact probability method were used for multi-group comparison, and non-parametric rank sum test was used for rank count data. Measurement data such as perioperative indexes were expressed with (), and t test was used for comparison among multiple groups. P<0.05 was considered statistically significant.

Results

There was no significant difference in LIMA and DIMA among IMA subtypes (P>0.05). In 107 patients, low IMA ligation was performed in type Ⅰ, type Ⅱ and type Ⅲ, and high IMA ligation was performed in type Ⅳ. The first postoperative exhaust time of group Ⅳ was significantly longer than that of group Ⅰ, type Ⅱ and type Ⅲ (P<0.05). The incidence of anastomotic leakage, defecation difficulty and the total incidence of complications in group Ⅳ were significantly higher than those in group Ⅰ to Ⅲ (P<0.05).

Conclusion

Preoperative three-dimensional vascular reconstruction was performed to understand IMA classification and determine the distance between IMA and left colic artery (LCA) and abdominal aorta, so as to select the most appropriate IMA ligation method, reduce the risk of collateral damage caused by blind surgery, and achieve the purpose of accurately preserving LCA, which has a positive effect on promoting the recovery of intestinal function in patients and reducing the incidence of anastomotic leakage.

表1 不同IMA分型四组患者一般临床资料比较
表2 不同IMA分型四组患者LMIA、DIMA比较(cm,
表3 不同IMA分型四组患者围手术期指标比较(
表4 不同IMA分型四组患者并发症发生情况比较(例)
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