切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (02) : 172 -176. doi: 10.3877/cma.j.issn.2095-3224.2023.02.014

手术视频

完全经腹入路保留左结肠血管括约肌间切除术(ISR)(附视频)
罗立雄1, 汪冠聪1, 姚开源1, 郑枝忠1, 郭银枞1,()   
  1. 1. 363000 福建医科大学附属漳州市医院结直肠肛门外科
  • 收稿日期:2022-09-01 出版日期:2023-04-25
  • 通信作者: 郭银枞
  • 基金资助:
    福建医科大学启航基金一般项目(2019QH1276)

The completely abdominal approach to intersphincteric resection (ISR) with the preservation of left colic artery for rectal cancer

Lixiong Luo1, Guancong Wang1, Kaiyuan Yao1, Zhizong Zheng1, Yincong Guo1,()   

  1. 1. Department of Colorectal Surgery of Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou 363000, China
  • Received:2022-09-01 Published:2023-04-25
  • Corresponding author: Yincong Guo
引用本文:

罗立雄, 汪冠聪, 姚开源, 郑枝忠, 郭银枞. 完全经腹入路保留左结肠血管括约肌间切除术(ISR)(附视频)[J]. 中华结直肠疾病电子杂志, 2023, 12(02): 172-176.

Lixiong Luo, Guancong Wang, Kaiyuan Yao, Zhizong Zheng, Yincong Guo. The completely abdominal approach to intersphincteric resection (ISR) with the preservation of left colic artery for rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(02): 172-176.

括约肌间切除术(ISR)是低位直肠癌的一种极限保肛手术,完全经腹入路报道较少。本中心成功施行该手术,旨在探讨该手术的规范和流程。

Intersphincteric resection (ISR) is an ultra-low sphincter- preserving operation. The completely abdominal approach to ISR has rarely been reported. This surgical procedure was successfully performed in our hospital, aiming to discuss the operation criterion.

图1 血管根部的处理。1A:腹主动脉的各分支;1B:裸化后的253组淋巴结区域;1C:IMP左侧束参与动脉鞘的构成;1D:血管的鞘内分离。(注明:IMA:肠系膜下动脉,LCA:左结肠动脉,SA:乙状结肠动脉,SRA:直肠上动脉,SMV:肠系膜下静脉,IMP:肠系膜下神经丛)
图2 盆底展示。2A:双侧腹下神经丛;2B:回缩的直肠耻骨肌;2C:进入括约肌间隙
图3 括约肌间手术的分型(图片摘自参考文献[9])
[1]
魏东. 低位直肠癌外科治疗现状与展望[J]. 世界华人消化杂志, 2016, 24(21): 3238-3247.
[2]
Dumont F, Mariani A, Elias D, et al. Surgical strategy for low rectal cancers[J]. J Visc Surg, 2015, 152(1): 23-31.
[3]
Murono K, Kawai K, Kazama S, et al. Anatomy of the inferior mesenteric artery evaluated using 3-dimensional CT angiography[J]. Dis Colon Rectum, 2015, 58(2): 214-219.
[4]
Cirocchi R, Trastulli S, Farinella E, et al. High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a RCT is needed[J]. Surg Oncol, 2012, 21(3): e111-123.
[5]
李心翔, 李清国. 腹腔镜直肠癌术中左结肠动脉保留的意义[J]. 中华胃肠外科杂志, 2018, 21(3): 272-275.
[6]
Hinoi T, Okajima M, Shimomura M, et al. Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer[J]. World J Surg, 2013, 37(12): 2935-2943.
[7]
尤小兰, 王元杰, 程之逸, 等. 腹腔镜直肠癌全直肠系膜切除术中保留左结肠动脉的临床研究[J]. 中华胃肠外科杂志, 2017, 20(10): 1162-1167.
[8]
Sekimoto M, Takemasa I, Mizushima T, et al. Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery[J]. Surg Endosc, 2011, 25(3): 861-866.
[9]
Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal tumours[J]. Br J Surg, 1994, 81(9): 1376-1378.
[10]
Tsukada Y, Ito M, Watanabe K, et al. Topographic anatomy of the anal sphincter complex and levator ani muscle as it relates to intersphincteric resection for very low rectal disease[J]. Dis Colon Rectum, 2016, 59(5): 426-433.
[11]
Nakajima Y, Muro S, Nasu H, et al. Morphology of the region anterior to the anal canal in males: visualization of the anterior bundle of the longitudinal muscle by transanal ultrasonography[J]. Surg Radiol Anat, 2017, 39(9): 967-973.
[12]
丛进春, 张宏. Hiatal韧带解剖研究的临床意义和应用[J]. 中国实用外科杂志, 2019, 39(7): 746-750.
[13]
Kraima AC, West NP, Roberts N, et al. The role of the longitudinal muscle in the anal sphincter complex: implications for the intersphincteric plane in low rectal cancer surgery?[J] Clin Anat, 2020, 33(4): 567-577.
[14]
Sakr A, Yang SY, Kang JH, et al. Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: Comparative cross sectional study[J]. J Surg Oncol, 2020, 121(2): 365-374.
[1] 康夏, 田浩, 钱进, 高源, 缪洪明, 齐晓伟. 骨织素抑制破骨细胞分化改善肿瘤骨转移中骨溶解的机制研究[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 329-339.
[2] 代莉, 邓恢伟, 郭华静, 黄芙蓉. 术中持续输注艾司氯胺酮对腹腔镜结直肠癌手术患者术后睡眠质量的影响[J]. 中华普通外科学文献(电子版), 2023, 17(06): 408-412.
[3] 王得晨, 杨康, 杨自杰, 归明彬, 屈莲平, 张小凤, 高峰. 结直肠癌微卫星稳定状态和程序性死亡、吲哚胺2,3-双加氧酶关系的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 462-465.
[4] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[5] 张生军, 赵阿静, 李守博, 郝祥宏, 刘敏丽. 高糖通过HGF/c-met通路促进结直肠癌侵袭和迁移的实验研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 21-24.
[6] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[7] 李婷, 张琳. 血清脂肪酸代谢物及维生素D水平与结直肠癌发生的关系研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 661-665.
[8] 付振保, 曹万龙, 刘富红. 腹腔镜直肠癌低位前切除术中不同缝合方法的回肠双腔造口术临床效果研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 684-687.
[9] 贺亮, 王松林, 周业江. 两种预防性回肠造口在腹腔镜ISR术治疗超低位直肠癌的效果对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 697-700.
[10] 倪文凯, 齐翀, 许小丹, 周燮程, 殷庆章, 蔡元坤. 结直肠癌患者术后发生延迟性肠麻痹的影响因素分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 484-489.
[11] 范小彧, 孙司正, 鄂一民, 喻春钊. 梗阻性左半结肠癌不同手术治疗方案的选择应用[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 500-504.
[12] 杨红杰, 张智春, 孙轶. 直肠癌淋巴结转移诊断研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 512-518.
[13] 马慧颖, 凡新苓, 覃仕瑞, 陈佳赟, 曹莹, 徐源, 金晶, 唐源. 磁共振加速器治疗局部晚期直肠癌的初步经验[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 519-523.
[14] 关旭, 王锡山. 基于外科与免疫视角思考结直肠癌区域淋巴结处理的功与过[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 448-452.
[15] 顾睿祈, 方洪生, 蔡国响. 循环肿瘤DNA检测在结直肠癌诊治中的应用与进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 453-459.
阅读次数
全文


摘要