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/OL]. 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/OL]. 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] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[2] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[3] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[4] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[5] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[6] 庄宝雄, 邓海军. 单孔+1腹腔镜直肠癌侧方淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 601-601.
[7] 张朝军, 袁新普. 腹腔镜辅助低位直肠癌根治术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 602-602.
[8] 郑民华, 蒋天宇, 赵轩, 马君俊. 中国腹腔镜直肠癌根治术30年发展历程与未来[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 591-595.
[9] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[10] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[11] 陈杰, 武明胜, 李一金, 李虎, 向源楚, 荣新奇, 彭健. 低位直肠癌冷冻治疗临床初步分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 494-498.
[12] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[13] 王灿, 樊昊, 张卫, 于冠宇. LARS 评分的研制回顾与应用现状[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 519-523.
[14] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[15] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?