[1]成军 周玲 陈涛 李晓刚 廖晓锋**.保留左结肠动脉的腹腔镜低位直肠癌前切除术[J].中国微创外科杂志,2017,17(09):780-782.
　Cheng Jun,Zhou Ling,Chen Tao,et al.Effect on Preservation of the Left Colonic Artery in Laparoscopic Anterior Resection of Low Rectal Carcinoma[J].Chinese Journal of Minimally Invasive Surgery,2017,17(09):780-782.
点击复制

保留左结肠动脉的腹腔镜低位直肠癌前切除术()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年09期
页码:
780-782
栏目:
临床论著
出版日期:
2017-09-20

文章信息/Info

Title:
Effect on Preservation of the Left Colonic Artery in Laparoscopic Anterior Resection of Low Rectal Carcinoma
作者:
成军 周玲 陈涛 李晓刚 廖晓锋**
湖北文理学院附属襄阳市中心医院普外科，襄阳441021
Author(s):
Cheng Jun;  Zhou Ling;  Chen Tao;  et al.
Department of General Surgery, Xiangyang Central Hospital, Xiangyang 441021, China
关键词:
低位直肠癌; 左结肠动脉; 肠系膜下动脉; 第3站淋巴结
Keywords:
Low rectal carcinoma; Left colonic artery; Inferior mesenteric artery; D3 lymph node
文献标志码:
A
摘要:
目的探讨腹腔镜低位直肠癌前切除术中处理肠系膜下动脉（inferior mesenteric artery,IMA)时保留左结肠动脉（left colonic artery,LCA)的可行性及临床价值。方法回顾性分析我院2010年5月~2014年10月85例腹腔镜低位直肠癌前切除术的临床资料，其中保留LCA 44例，IMA根部结扎（不保留LCA）41例，比较2组临床病理资料、手术效果及术后并发症。结果2组手术时间、术中出血量、术后排气时间、第3站淋巴结清扫数目及转移率均无显著性差异（P>0.05）。保留LCA组无游离脾曲及末端回肠造口，不保留LCA组6例游离脾曲（P=0.010），3例行末端回肠造口（P=0.108）。2组术后吻合口漏、复发、转移率差异无统计学意义（P>0.05）。结论腹腔镜低位直肠癌前切除术保留LCA可以保障近端结肠血运，保证第3站淋巴结根治性。
Abstract:
ObjectiveTo discuss the feasibility and clinical significance of preservation of the left colonic artery (LCA) in laparoscopic anterior resection of low rectal carcinoma.MethodsThe clinical data of 85 cases of laparoscopic low rectal anterior resection in our hospital from May 2010 to October 2014 were retrospectively analyzed, including 44 cases with preservation of LCA and 41 cases without preservation of LCA. The surgical effect, clinical pathological parameters and postoperative complications were compared between the two groups.ResultsThere were no differences in surgical time, blood loss, postoperative exhaust time, and the number of D3 lymph nodes between the two groups (P>0.05). No case in the preservation group needed the dissection of the splenic flexure of colon or terminal ileum stoma, while there were 6 cases in the non-preservation group needed the dissection of the splenic flexure of colon (P=0.010) and 3 cases receiving terminal ileum stoma following anastomosis (P=0.108). The incidences of anastomotic leakage, recurrence and liver metastasis were similar between the two groups (P>0.05). ConclusionLaparoscopic anterior resection of low rectal carcinoma with preservation of the LCA can effectively retain the blood supply of proximal and ensure radical dissection of D3 lymph nodes.

参考文献/References:

[1]Homma Y,Hamano T,Qtsuki Y,et al.Severe tumor budding is a risk factor for lateral lymph node metastasis in early rectal cancers.J Surg Oncol,2010,102(3):230-234.
[2]渡邉昌彦，上西纪夫，俊藤满一,等著.张宏,主译.消化外科手术图解5:直肠肛门外科手术操作要领与技巧.北京:人民卫生出版社,2012.17-18.
[3]Hida J,Yasutomi M,Maruyama T,et al.Indication for usng high ligation of the inferior mesenteric by the clearing methods.Dis Colon Rectum,1998,41(8):984-987.
[4]Fazio S,Ciferri E,Giacchino P,et al.Cancer of the rectum: comparison of two different surgical approaches.Chir ital,2004,56(1):23-30.
[5]朱军,丁建华,汤海燕.腹腔镜与开腹全直肠系膜切除术治疗中低位直肠癌的临床对照研究.中国普外基础与临床杂志,2012,19(16):636-641.
[6]National Comprehensive Cancer Network.NCCN Clinical Practice Guidelines in Oncology:rectal cancer.Version 1.Washington:National Comprehensive Cancer Network,2015.
[7]Augestad KM,Lindsetmo RO,Reynolds H,et al.ASCRS Clinical Practic Guidelines:rectal cancer.Am J Surg,2011,201(3):353-357.
[8]沈荐,李敏哲,杜燕夫.腹腔镜直肠癌前切除术中保留左结肠动脉与否的临床对照研究.中国微创外科杂志,2014,14(1):22-28.
[9]Lange MM,Buunen MM,van de Velde CJ,et al.Level of arterial ligation in rectal cancer surgery:low tie preferred over high tie.A review.Dis Colon Rectum,2008,51(7):1139-1145.
[10]程邦昌,昌盛,黄杰,等.结肠代食管术中结肠血管结构的研究.中华医学杂志,2006,86(21):1453-1456.
[11]渠浩,李志霞,杜燕夫,等.腹腔镜直肠乙状结肠手术近端肠管的保护.中华胃肠外科杂志,2012,15(1):17-18.
[12]Seike K,Koda K，Saito N,et al.Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow inrectosigmoid cancer surgery.Int J Colorectal Dis,2007,22(6):689-697.
[13]Guo Y,Wang D,He L,et al.Marginal artery stump pressure in left colic artery-preserving rectal cancer surgery:a clinical trial.ANZ J Surg,2015,23(2):1433-1445.

备注/Memo

备注/Memo:
基金项目：襄阳市科技局课题（襄科计［2014］9-1）**通讯作者，E-mail:xfliao@medmail.com.cn
更新日期/Last Update: 2017-11-27