目的

对比分析不同肠系膜下静脉（IMV）结扎水平的直肠癌全直肠系膜切除术（TME）临床效果。

方法

前瞻性选取于2020年1月～2022年12月腹腔镜下行TME的60例直肠癌患者为研究对象，并采用随机数字表法将其分为高位结扎组和低位结扎组，每组各30例。高位结扎组于胰腺下缘水平结扎离断IMV，低位结扎组于肠系膜下动脉（IMA）根部水平结扎离断IMV。数据分析采用SPSS 25.0完成，围手术期各指标等计量资料用（± s）表示，行独立样本t检验；术后并发症等计数资料用［例（%）］表示，行χ²检验；Kaplan-Meier法绘制生存曲线并行Log-Rank检验。以P＜0.05表示差异有统计学意义。

结果

两组患者在手术时间、术中出血量、淋巴结清扫枚数、阳性淋巴结枚数、腹腔引流量及Wexner评分上比较，差异均未见统计学意义（P＞0.05），而低位结扎组肠功能恢复时间及术后住院时间较高位结扎组显著降低（P＜0.05）。两组患者术后并发症总发生率（20.0% vs.16.7%）差异无统计学意义（P＞0.05）。通过Kaplan-Meier 生存分析显示，高位结扎组和低位结扎组患者累积无病生存率（86.7% vs. 83.3%）及累积总生存率（90.0% vs.86.7%）比较，差异均无统计学意义（P＞0.05）。

结论

在直肠癌TME中对IMV进行高位结扎和低位结扎均是安全可行的，低位结扎IMV在不影响肿瘤根治的前提下，更有利于患者术后肠道功能的恢复，加速术后康复，具有更好的临床效果。

Objective

To compare and analyze the clinical effect of total mesorectal resection (TME)for rectal cancer at different levels of submesenteric vein (IMV) ligation.

Methods

Sixty patients with rectal cancer undergoing laparoscopic TME from January 2020 to December 2022 were prospectively selected as the study objects, and were divided into high ligation group and low ligation group by random number table method, with 30 cases in each group.The IMV was ligated horizontally at the lower pancreatic margin in the high ligation group, and the IMV was ligated horizontally at the root of the inferior mesenteric artery (IMA) in the low ligation group.SPSS 25.0 was used to complete the data analysis.All perioperative indicators and other measurement data were represented by (x±s) and independent sample t test was performed.The statistical data of postoperative complications were expressed by［ cases (%)］ and χ² test was performed.Kaplan-Meier method was used to draw survival curve and parallel Log-Rank test.P＜0.05 indicated that the difference was statistically significant.

Results

There was no significant difference in operation time, intraoperative blood loss, number of lymph nodes dissection, number of positive lymph nodes, intraperitoneal drainage flow and Wexner score between the two groups (P＞0.05), while the recovery time of intestinal function and postoperative hospital stay in the low ligation group were significantly lower than those in the high ligation group (P＜0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(20.0% vs.16.7%) (P＞0.05).Kaplan-Meier survival analysis showed that cumulative disease-free survival (86.7%vs.83.3%) and cumulative overall survival (90.0% vs.86.7%) were not statistically significant between the high ligation group and the low ligation group (P＞0.05).

Conclusion

Both high ligation and low ligation of IMV in TME of rectal cancer are safe and feasible.Low ligation of IMV is more conducive to postoperative intestinal function recovery of patients, accelerates postoperative rehabilitation and has better clinical effect without affecting radical tumor treatment.