Objective To investigate the effect of ligation level of inferior mesenteric artery (IMA) on postoperative defecation function in patients with rectal cancer.Methods A total of 128 rectal cancer patients who were planned to undergo low anterior resection in the First Hospital of Zibo City between January 1, 2012 and December 31, 2013 were prospectively enrolled and randomly divided into IMA high ligation group (63 cases, cutting distance of 1.0 to 1.5 cm to the root of IMA) and low ligation group (65 cases, cutting distance of 0.5 to 1.0 cm to the root of left colic artery originated from IMA).The efficacy, especially the defecation function, was observed and compared 3 months and 1 year after surgery between the two groups.Results No significant difference was found in the number of harvested lymph nodes between two groups[8(1-30) vs.7(2-28), P=0.125], but high ligation group had greater number of metastatic lymph nodes[1 (0-9) vs.0(0-8), P=0.041].Frequency of defecation in high ligation group was significantly higher than that in low ligation group during postoperative 3-month follow-up[5(2-10)/d vs.3(1-8)/d, P=0.035], whereas other indexes of defecation function were not significantly different (all P＞0.05).The proportion of patients needing laxatives in high ligation group was higher than that in low ligation group during postoperative 1-year follow-up [11.3％(6/53) vs.1.7％(1/58), P=0.038], whereas other indexes of defecation function were not significantly different as well (all P＞0.05).Three cases and 2 cases showed recurrence in high ligation group and low ligation group respectively during postoperative 1-year follow-up without significant difference (P=0.623).Conclusion Low ligation of IMA in low anterior resection for rectal cancer is beneficial to the protection against defecation function.%目的 探讨低位前切除术中不同肠系膜下动脉(IMA)结扎水平对直肠癌患者术后排粪功能的影响.方法 前瞻性纳入2012年1月1日至2013年12月31日期间山东省淄博市第一医院收治并拟行低位前切除术的128例直肠癌患者,随机分至IMA高位结扎组(63例,距IMA根部1.0～1.5 cm切断)和低位结扎组(65例,距IMA发出的左结肠动脉根部0.5～1.0 cm切断),观察两组患者术后3月和1年的排粪功能情况及其他术后疗效.结果 高位结扎组与低位结扎组术中清扫淋巴结数目差异无统计学意义[8(1～30)枚/例比7(2～28)枚/例,P=0.125];但高位结扎组转移性淋巴结数目更多[1(0～9)枚/例比0(0～8)枚/例,P=0.041].术后3月,高位结扎组平均排粪次数明显多于低位结扎组[5(2～10)次/d比3(1～8)次/d,P=0.035],而其他排粪功能评价指标的差异均无统计学意义(均P＞0.05).术后1年,高位结扎组需要使用泻剂的患者比例高于低位结扎组[6例(11.3％,6/53)比1例(1.7％,1/58),P=0.038],而其他排粪功能评价指标的差异均无统计学意义(均P＞0.05).术后随访1年,高位结扎组和低位结扎组分别有3例(5.7％,3/53)和2例(3.4％,2/58)患者出现肿瘤复发,差异无统计学意义(P=0.623).结论 低位前切除术中低位结扎IMA有助于保护患者的排粪功能.
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