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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (05) : 502 -506. doi: 10.3877/cma.j.issn.2095-3224.2020.05.012

所属专题： 文献；

综述

肠系膜下动脉分型在腹腔镜直肠癌手术中保留左结肠动脉的应用价值
骆洋1, 钟鸣2,†()   
  1. 1. 200127　上海交通大学医学院附属仁济医院胃肠外科
    2. 200127　上海交通大学医学院附属仁济医院胃肠外科；315336　宁波市杭州湾医院普外科
  • 收稿日期:2020-03-20 出版日期:2020-10-25
  • 通信作者: 钟鸣
  • 基金资助:
    国家自然科学基金项目(No. 81802308，81672347); 上海市科学技术委员会(No.19411966200)

The clinical value of inferior mesenteric arterial classification for preserving left colon artery in laparoscopic radical resection of rectal cancer

Yang Luo1, Ming Zhong2,†()   

  1. 1. Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
    2. Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Department of General Surgery, Ningbo Hangzhou Bay Hospital, Ningbo 315336, China
  • Received:2020-03-20 Published:2020-10-25
  • Corresponding author: Ming Zhong
  • About author:
    Corresponding author: Zhong Ming, Email:
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骆洋, 钟鸣. 肠系膜下动脉分型在腹腔镜直肠癌手术中保留左结肠动脉的应用价值[J/OL]. 中华结直肠疾病电子杂志, 2020, 09(05): 502-506.

Yang Luo, Ming Zhong. The clinical value of inferior mesenteric arterial classification for preserving left colon artery in laparoscopic radical resection of rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(05): 502-506.

吻合口漏是腹腔镜直肠癌围手术期的主要并发症之一。为降低其发生率，外科医师在手术过程中选择保留左结肠动脉来增加吻合口血供。但由于肠系膜下动脉（IMA）的分支变异较大，术前对IMA分型以及周围结构判断不足，在手术过程中处理IMA根部时导致各种意外出血，而被迫选择结扎IMA根部。利用CT血管重建技术对IMA进行影像学分型，一方面有利于精准保留左结肠动脉，减少不必要的手术时间；另一方面有助于判断左结肠动脉和肠系膜下静脉之间的关系，达到规范化清扫D3站淋巴结的目的。因此，笔者认为，应将"通过CT血管重建技术对IMA进行精准化分型"纳入诊疗规范中，使直肠癌的外科治疗更加个体化，精准化；但这尚需要多中心大样本的前瞻性研究来提供循证医学证据。

关键词: 直肠肿瘤, 腹腔镜, 腹腔镜直肠癌手术, 肠系膜下动脉分型, 左结肠动脉, CT血管重建

Anastomotic leakage is one of the severe complications of laparoscopic assisted-resection of rectal cancer. In order to increase the blood pressure of anastomosis, many surgeons choose to be preserved the left colon artery during operation. However, due to the large branch variation of the inferior mesenteric artery (IMA), the artery bleeding was frequently by various accidents during the operation. The vascular reconstruction for the classification of the IMA could accurately preserve the left colon artery (LCA), and completely dissected D3 lymph nodes. Therefore, we think that the "accurate classification of the inferior mesenteric artery by abdominal CT vascular reconstruction" should be routine examination before rectal cancer surgery. However, in the further, this requires a multi-center large sample clinical studies to provide medical evidence.

Key words: Rectal Neoplasms, Laparoscopes, Laparoscopic assisted-resection of rectal cancer, Inferior mesenteric artery classification, Left colonic artery, CT vascular reconstruction
图1 肠系膜下动脉两种结扎方式。1A：高位结扎：肠系膜下动脉根部结扎；1B：低位结扎：保留LCA
图2 肠系膜下血管各种意外性出血。2A~2C：肠系膜下动脉根部出血；2D~2E：肠系膜下静脉出血；2F~2H：左结肠动脉根部出血。IMA：肠系膜下动脉，IMV：肠系膜下静脉，LCA：左结肠动脉
图3 保留左结肠动脉的两种方式。3A：保留左结肠动脉，253组淋巴结未清扫；3B：保留左结肠动脉，253组淋巴结规范化清扫。LCA：左结肠动脉
图4 肠系膜下动脉四种分型。4A：IMA四种分型手绘模式图以及保留LCA四种方式；4B：三维血管成像显示的IMA四种分型
图5 253组淋巴结清扫范围。5A：253组淋巴结清扫范围模式图；5B：腹腔镜直肠癌手术中253组淋巴结清扫范围。LCA：左结肠动脉，IMV：肠系膜下静脉，SRA：直肠上动脉，IMA：肠系膜下动脉
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