Comparative Study On Low Ligation And High Ligation Of Inferior Mesenteric Artery In Resection Of Rectal Cancer

【Objective】To evaluate whether low ligation of inferior mesenteric artery and lymph nodesdissection is more secure and reasonable than high ligation of inferior mesenteric artery andlymph nodes dissection on radical resection for rectal cancer, so that we can achieve anormalization and standardization for rectal cancer. It can provide theoretical basis for thechoice of the type of resection in rectal cancer surgery.【Methods】1.80patients who are suitable for total mesorectal excision surgery are randomly dividedinto two groups, the patients less than or equal to T3can undergo surgery directly, thepatients greater than T3should undergo surgery after neoadjuvant chemoradiation. The lowligation group was treated with low ligation of IMA and lymph nodes dissection, the highligation group was cured by high ligation of IMA and lymph nodes dissection;2.The peak systolic velocity and end diastolic velocity of marginal artery on proximalanastomosis are detected by Color Doppler during surgery. The operation time, blood loss,vascular injury are observed at the same time;3.The type of specimens, tumor diameter, depth of tumor invasion, the range ofcircumference of the bowel, histopathologic type, the negative rate of circumferentialresection margin(CRM), number of lymph nodes and lymph nodes metastasis are observedafter surgery, the rate of intraoperative perforation must be observed for low rectal cancer;4.To observe the intestinal function recovery time, urinary retention rate, anastomoticleakage rate, sexual dysfunction rate and low anterior resection syndrome incidence, and theincidence of other postoperative complications.【Results】1.The peak systolic velocity and end diastolic velocity of marginal artery on proximalanastomosis in the low ligation group are significantly higher than the high ligation group（P ＜0.05）. Compared two groups of operation time, blood loss and vascular injury rate, there isno significant differences（P＞0.05）;2.The difference is not statistically significant in the type of specimens, tumor diameter,depth of tumor invasion, the range of circumference of the bowel, histopathologic type, thenegative rate of circumferential resection margin(CRM), number of lymph nodes and lymphnodes metastasis between the two groups（P＞0.05）. There are no intraoperative perforationboth in the low ligation group and he high ligation group;3.The intestinal function recovery time and low anterior resection syndrome incidence ofthe low ligation group are lower than the high ligation group（P＜0.05）. Compared twogroups of average hospitalization time, urinary retention rate, anastomotic leakage rate,sexual dysfunction rate and other postoperative complications, there are no significantdifferences（P＞0.05）.【Conclusions】1.Compared with the high ligation of inferior mesenteric artery and lymph nodesdissection, low ligation of inferior mesenteric artery and lymph nodes dissection can achieveradical resection for rectal cancer and without increasing the operation time and postoperativecomplications;2.The peak systolic velocity and end diastolic velocity of marginal artery on proximalanastomosis increase significantly after low ligation of inferior mesenteric artery, it isconducive to the intestinal function recovery and reduce the incidence of low anteriorresection syndrome.