[1]康博雄,夏博伟,樊勇,等.腹腔镜下头侧中间入路在保留左结肠动脉的Dixon手术中的应用(附22例报告)[J].中国微创外科杂志,2017,17(10):987-908.
 Kang Boxiong,Xia Bowei,Fan Yong,et al.Application of Head-medial Approach in Laparoscopic Anterior Resection of Rectal Carcinoma with Preservation of the Left Colonic Artery: Report of 22 Cases[J].Chinese Journal of Minimally Invasive Surgery,2017,17(10):987-908.
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腹腔镜下头侧中间入路在保留左结肠动脉的Dixon手术中的应用(附22例报告)()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年10期
页码:
987-908
栏目:
临床研究
出版日期:
2017-10-20

文章信息/Info

Title:
Application of Head-medial Approach in Laparoscopic Anterior Resection of Rectal Carcinoma with Preservation of the Left Colonic Artery: Report of 22 Cases
作者:
康博雄夏博伟樊勇刘永永康迎新王品伏洁王琛*
兰州大学第二医院普外四科,兰州730030
Author(s):
Kang Boxiong Xia Bowei Fan Yong et al.
Department of General Surgery Ⅳ, Lanzhou University Second Hospital, Lanzhou 730030, China
关键词:
腹腔镜头侧中间入路直肠癌前切除低位吻合术左结肠动脉吻合口漏
Keywords:
LaparoscopyHead-medial approachAnterior resection of rectal carcinomaLeft colonic arteryAnastomotic leakage
文献标志码:
A
摘要:
目的探讨腹腔镜下头侧中间入路方法在保留左结肠动脉(left colic artery,LCA)的腹腔镜直肠癌前切除低位吻合术(Dixon手术)的可行性及应用价值。方法对术前分期为Ⅰ、Ⅱ、ⅢA期拟行Dixon 术的22例直肠癌行保留LCA的腹腔镜Dixon手术,采用头侧中间入路自屈氏韧带下方先分离解剖降结肠后间隙,再进入乙状结肠后间隙,并解剖出肠系膜下动脉(inferior mesenteric artery,IMA)各分支,清扫血管周围脂肪和淋巴结,保留LCA,于其分叉下缘切断IMA。结果22例手术均获成功,手术时间110~280 min,平均150 min;术中出血10~75 m1,平均25 m1。术中无直肠破裂穿孔,无输尿管及邻近器官损伤,检查吻合口远近端肠管血运良好,经肛门注气检查无吻合口漏,近端吻合肠管呈自然弯曲下垂无张力。IMA周围淋巴结清扫4~8枚,平均6.2枚。术后病理:高分化腺癌5例,中分化腺癌10例,低分化腺癌7例;IMA根部淋巴结均为阴性,2例直肠系膜淋巴结为阳性。术后无发生吻合口漏等并发症。22例术后随访9~36个月,平均17.2月,无远期并发症、复发及转移。结论腹腔镜下头侧中间入路保留LCA的Dixon手术安全可行,可以清晰便捷解剖显露IMA各分支,在不增加吻合口张力,不影响IMA行周围淋巴结清扫的基础上,为吻合口提供更充足的血运,降低吻合口漏的发生。
Abstract:
ObjectiveTo evaluate the feasibility and efficacy of head-medial approach in laparoscopic anterior resection of rectal carcinoma (Dixon) with preservation of the left colonic artery(LCA).MethodsFrom April 2012 to March 2014, 22 patients with rectal carcinoma (clinical stage Ⅰ, Ⅱ and ⅢA) received laparoscopic Dixon surgery. The inferior mesenteric artery (IMA) and the branches were dissected through head-medial approach, from the ligament of Traitz, then the posterior space of descending colon, and to the posterior space of sigmoid colon. The lymph nodes and perivascular adipose tissue were dissected through the vasa vasorum approach. The LCA was retained by transecting the IMA inferior to the left colonic artery. ResultsThe operation was successfully completed in all the 22 cases. The operative time ranged from 110 to 280 min, with a mean of 150 min. The mean intraoperative hemorrhage was 25 ml (range, 10-75 ml). None of the patients had perforation of the rectum, injuries to blood vessel, ureter or adjacent organs, or anastomotic tension. The number of dissected lymph nodes surrounding the IMA ranged from 4 to 8, with a mean of 6.2. The postoperative pathological outcomes showed 5 cases of highly differentiated adenocarcinoma, 10 cases of moderately differentiated adenocarcinoma, and 7 cases of poorly differentiated adenocarcinoma. The dissected lymph nodes in the base of the IMA showed no cancer cell metastasis but there were 2 positive mesenteric lymph nodes. None of patients had anastomotic leakage. Follow-ups were conducted for 9-36 months with an average of 17.2 months in 22 cases, and no long-term postoperative complications and local recurrence occurred in all the cases. ConclusionsHead-medial approach laparoscopic anterior resection of rectal carcinoma with preservation of the LCA is safe and feasible. This surgical approach preserves more supplying vessels and prevents anastomotic leakage without increasing the anastomotic tension or affecting lymph node dissection surrounding the IMA.

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备注/Memo

备注/Memo:
*通讯作者,E-mail:wcdfjack@163.com
更新日期/Last Update: 2018-01-11