Candela Giancarlo, Di Libero Lorenzo, Varriale Sergio, Manetta Fiorenza, Giordano Marco, Maschio Antonio, Argenziano Giacomo, Pizza Alessandra, Sciascia Valerio, Napolitano Salvatore, Santini Luigi
VII Department of General Surgery, Second University of Studies of Naples, Rome.
Chir Ital. 2008 Jan-Feb;60(1):75-81.
In spite of numerous studies on the subject, it is still unclear whether or not high ligation of the inferior mesenteric artery (at about 1 cm from its origin) improves the 5-year survival rate in patients operated on for colorectal cancer in comparison to low ligation (ligation below the origin of the left colic artery). From February 2000 to November 2001 40 patients with cancer of the colic segment between the descending sigmoid junction and the low rectum underwent surgical colorectal resection and low ligation of the inferior mesenteric artery. At the end of 5 years of observation we report a survival rate of 70% which is not very far from the value reported in the literature. In our study, the incidence of lymph-node metastases, inexistent in patients with T1 grading increases with the increase in the TNM T grading but does not depend on the location of the cancer. In our patients age below 65 years was a negative prognostic indicator because colorectal tumours in patients of that age are associated with a higher incidence of lymph-node metastases. On the basis of the data we obtained, it is also evident that the 5-year survival rate decreases in proportion to the increase in the distance of the lymph-node metastases from the mesenteric margin of the colon. In conclusion, in the treatment of cancers located between the descending sigmoid junction and the low rectum, we prefer to execute a low ligation of the inferior mesenteric artery because it exposes the patient to a lower risk of intra- and postoperative complications and also because several authors have demonstrated that high ligation with removal of lymph nodes at the origin of the artery for colorectal cancer does not improve the 5-year survival rate.
尽管针对该主题进行了大量研究，但与低位结扎（在左结肠动脉起始部下方进行结扎）相比，肠系膜下动脉高位结扎（在距其起始部约1 cm处）是否能提高接受结直肠癌手术患者的5年生存率仍不清楚。2000年2月至2001年11月，40例降乙状结肠交界处至低位直肠之间结肠段癌患者接受了结直肠手术切除及肠系膜下动脉低位结扎。在5年观察期结束时，我们报告的生存率为70%，这与文献报道的值相差不大。在我们的研究中，T1分级患者不存在淋巴结转移，淋巴结转移发生率随TNM T分级增加而升高，但不取决于癌症的位置。在我们的患者中，65岁以下是一个不良预后指标，因为该年龄段患者的结直肠肿瘤与更高的淋巴结转移发生率相关。根据我们获得的数据，还明显可见5年生存率与淋巴结转移距结肠系膜缘的距离增加成比例下降。总之，在治疗降乙状结肠交界处至低位直肠之间的癌症时，我们更倾向于进行肠系膜下动脉低位结扎，因为这使患者面临的术中和术后并发症风险较低，而且一些作者已证明，对结直肠癌进行动脉起始部淋巴结清扫的高位结扎并不能提高5年生存率。
