腹腔镜直肠癌根治术保留左结肠动脉关键技术与意义
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摘要
腹腔镜直肠癌根治术保留左结肠动脉是近年临床上争议的热点,也有其发展的过程。前腹腔镜时代直肠癌手术更多的是低位结扎肠系膜下动脉(IMA),保留或不保留左结肠动脉(LCA),一般不清扫系膜根部淋巴结(253组),近年随着手术越来越规范,更多的强调行253组淋巴结清扫,为了手术方便多行IMA根部离断,不保留LCA,同时带来一系列临床问题的探讨,又提出保留左结肠动脉直肠癌根治术。本文列举腹腔镜直肠癌根治术中保留左结肠动脉的要求、关键技术、以及临床意义,更多的是结合自己的体会,认为保留左结肠动脉一定要在根治的前提下,在腹腔镜下更易做好,该术式改进有很多优点和重要的临床意义。
Preserving the left colonic artery( LCA) during the laparoscopic radical resection for rectal cancer has been a controversial topic in clinical practice in recent years,and it also has its own development process. Among the pre-laparoscopic era,the inferior mesenteric artery( IMA) was ligatured,LCA was reversed randomly,also,the IMA root nodes( 253 nodes) was not cleaned generally. Along with the development of standard operating procedure colorectal cancer,the significant for thedissection of root node has been emphasized. However,due to thesimple procedure,the IMA was ligatured frequently instead of the reversed of LCA which induced a series of clinical question for discussion with the proposer to keep the LCA for colorectal cancer radical prostatectomy. In this study,we enumerated the requirements,key technologies and clinical significance of preserving LCA in laparoscopic radical rectal cancer resection. More importantly,based on my own experience,I believe that preserving LCAmust conducted under the premise of radical resection,and it is easierimplement under laparoscopy. The improvement of this surgical method has many advantages and important clinical significance.
Preserving the left colonic artery( LCA) during the laparoscopic radical resection for rectal cancer has been a controversial topic in clinical practice in recent years,and it also has its own development process. Among the pre-laparoscopic era,the inferior mesenteric artery( IMA) was ligatured,LCA was reversed randomly,also,the IMA root nodes( 253 nodes) was not cleaned generally. Along with the development of standard operating procedure colorectal cancer,the significant for thedissection of root node has been emphasized. However,due to thesimple procedure,the IMA was ligatured frequently instead of the reversed of LCA which induced a series of clinical question for discussion with the proposer to keep the LCA for colorectal cancer radical prostatectomy. In this study,we enumerated the requirements,key technologies and clinical significance of preserving LCA in laparoscopic radical rectal cancer resection. More importantly,based on my own experience,I believe that preserving LCAmust conducted under the premise of radical resection,and it is easierimplement under laparoscopy. The improvement of this surgical method has many advantages and important clinical significance.
引文
[1]张忠涛,杨盈赤.腹腔镜直肠癌根治术难点与争议[J/CD].中华普外科手术学杂志(电子版),2018,12(1):1-4.
[2]陈纲,李世拥.腹腔镜直肠癌根治保留左结肠血管的技巧及意义[J/CD].中华普外科手术学杂志(电子版),2018,12(1)9-12.
[3]许涛,胡江涛.肠系膜下动脉低位结扎和高位结扎对.腹腔镜直肠癌根治术的疗效影响[J/CD].中华普外科手术学杂志(电子版),2018,12(2)144-148.
[4]王成正,吴恒龙,周迎春等.腹腔镜辅助TME与开腹TME治疗超地位直肠癌的临床效果分析[J/CD].中华普外科手术学杂志(电子版),2017,11(6)500-503.
[5] MA Meyers. Griffiths’point:critical anastomosis at the splenic flexure. Significance in ischemia of the colon. American Journal of Roentgenology. 1976; 26:77-94.
[6] Miyamoto R,et al. Three-dimensional reconstruction of the vascular arrangement including the inferior mesenteric artery and left colic artery in laparoscope-assisted colorectal surgery. Surgical Endoscopy and other Interventional Techniques. 2016; 30(10):4400-4404.
[7]李世拥.腹部无切口腹腔镜直肠癌根治经肛门切除吻合术的实践与发展[J/CD].中华普外科手术学杂志(电子版),2016,10(2)91-94.
[8]王锡山.结直肠肿瘤类-NOTES手术的实践与技巧[J/CD].中华普外科手术学杂志(电子版),2016,10(2)94-97.
[9] M. Watanabe,M. et al. Double Primary Gastric and Colorectal Cancer:Is the Better Prognosis Synchronous or Metachronous?. American Journal of Clinical Oncology,2012; 35(5):407-410.
[10]郑民华.不断提高腹腔镜直肠癌外科规范化治疗水平[J/CD].中华普外科手术学杂志:电子版,2013,7(2):81-84.
[11]周总光.腹腔镜直肠癌根治应关注的若干问题[J/CD].中华普外科手术学杂志:电子版,2013,7(2):85-87.
[12]杨盈赤,金岚,张忠涛.完全经肛门TME腹腔镜直肠癌手术的实践与技巧[J/CD].中华普外科手术学杂志:电子版,2016,10(2):97-100.
[2]陈纲,李世拥.腹腔镜直肠癌根治保留左结肠血管的技巧及意义[J/CD].中华普外科手术学杂志(电子版),2018,12(1)9-12.
[3]许涛,胡江涛.肠系膜下动脉低位结扎和高位结扎对.腹腔镜直肠癌根治术的疗效影响[J/CD].中华普外科手术学杂志(电子版),2018,12(2)144-148.
[4]王成正,吴恒龙,周迎春等.腹腔镜辅助TME与开腹TME治疗超地位直肠癌的临床效果分析[J/CD].中华普外科手术学杂志(电子版),2017,11(6)500-503.
[5] MA Meyers. Griffiths’point:critical anastomosis at the splenic flexure. Significance in ischemia of the colon. American Journal of Roentgenology. 1976; 26:77-94.
[6] Miyamoto R,et al. Three-dimensional reconstruction of the vascular arrangement including the inferior mesenteric artery and left colic artery in laparoscope-assisted colorectal surgery. Surgical Endoscopy and other Interventional Techniques. 2016; 30(10):4400-4404.
[7]李世拥.腹部无切口腹腔镜直肠癌根治经肛门切除吻合术的实践与发展[J/CD].中华普外科手术学杂志(电子版),2016,10(2)91-94.
[8]王锡山.结直肠肿瘤类-NOTES手术的实践与技巧[J/CD].中华普外科手术学杂志(电子版),2016,10(2)94-97.
[9] M. Watanabe,M. et al. Double Primary Gastric and Colorectal Cancer:Is the Better Prognosis Synchronous or Metachronous?. American Journal of Clinical Oncology,2012; 35(5):407-410.
[10]郑民华.不断提高腹腔镜直肠癌外科规范化治疗水平[J/CD].中华普外科手术学杂志:电子版,2013,7(2):81-84.
[11]周总光.腹腔镜直肠癌根治应关注的若干问题[J/CD].中华普外科手术学杂志:电子版,2013,7(2):85-87.
[12]杨盈赤,金岚,张忠涛.完全经肛门TME腹腔镜直肠癌手术的实践与技巧[J/CD].中华普外科手术学杂志:电子版,2016,10(2):97-100.