The Clinical Comparison Of High And Low Ligation Of IMA In Non-type? Mesosigmoid Laparoscopic Dixon

Objective:To explore the clinical value of low ligation of inferior mesenteric artery in laparoscopic Dixon of non-Type ? sigmoid colon mesangial.Methods:According to inclusion and exclusion criteria,ninety-five cases of non-Type ? SMC rectal cancer patients who evaluated for feasibility of laparoscopic Dixon in the Department of Gastrointestinal Surgery Affiliated Tumor Hospital of Xinjiang Medical University from September 2017 to February 2019 were selected for research,and they were randomly divided into two groups:the group of low ligation(45 cases,IMA was ligated intraoperatively from its distal which has branched the left colonic artery)and the group of high ligation(50 cases,IMA was ligated intraoperatively from its proximal which has not branched the left colonic artery).A three-dimensional computed tomography angiography of inferior mesenteric artery was obtained in all patients,to guide the intraoperative accurate ligation of vessels.The baswline data,intraoperative and postoperative quantitative parameters of the two groups were recorded and compared.Results: Four patients in the group of left colic artery reserved were forced to turn to high ligation for it could not meet the requirement of anastomosis of free tension.The high ligation group showed significant difference to the low ligation group on operation time and the count of D3 lymph node,(P <0.05),and the operation time of the high ligation group,which is [200(180,230)]min,is littler than the low ligation group,whose operation time is [220(210,240)]min.The count of D3 lymph node,which is[2(1,3)],is better than the low ligation group,whose the count of D3 lymph node is[1(1,2)],P=0.037.But there was no significant difference in the aspect of gender,age,BMI,distance between tumor and anal border,TNM stage,intraoperative blood loss,prophylactic stoma rate,the splenic free rate,length of specimen,maximum diameter of tumor,tissue typing,the total count of lymph node,postoperative first exhaust time,indwelling catheter time,days in hospital since surgery and anastomotic fistula rate.(P>0.05).Conclusion:High ligation of inferior mesenteric artery in non-Type ?mesosigmoid laparoscopic Dixon can shorten the operation time and it has more predominant in getting D3 lymph node.But,in the field of the prevention of anastomotic fistula,low ligation of IMA is advantageous,because it can provide more blood supply.Therefore the comprehensive analysis of the specific conditions of the patients before and during the operation should be carried out,so that we can choose a way to maximize benefits.