Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan.
Surg Endosc. 2011 Mar;25(3):861-6. doi: 10.1007/s00464-010-1284-7. Epub 2010 Aug 20.
Curative resection of sigmoid and rectal cancer includes "high tie" of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the leakage rate. Accordingly, some surgeons employ a technique of lymph node (LN) dissection around the IMA, preserving the IMA and left colic artery (LCA). The same technique was reported to need longer time in laparoscopic surgery due to technical difficulties. We present herein a simple and secure method of laparoscopic LN dissection around the IMA that allows preservation of the IMA and LCA, and report the operative results.
Our method involves peeling off the vascular sheath from the IMA and dissection of the LN around the IMA together with the sheath. The feasibility of the technique was evaluated in 72 consecutive cases of laparoscopic resection of sigmoid and rectal cancer.
The IMA was ligated at its root in 27 cases (high tie, group A). Lymph nodes around the IMA were dissected with preservation of the IMA and LCA in 21 cases (group B). The root of the superior rectal artery was ligated in 24 cases of Tis and T1N0 ("low tie," group C). Mean operative time was 207.6, 221.2, and 198.5 min for group A, B, and C, respectively. Respective blood loss was 47.8, 44.0, and 58.5 g, and mean numbers of harvested LN were 17.3, 16.3, and 10.7. None of the operative results of groups A and B were different statistically. LN dissection was not associated with any morbidity.
Our method allows equivalent laparoscopic lymph node dissection to the high tie technique without excessive operative time or bleeding.
乙状结肠和直肠的根治性切除术包括肠系膜下动脉（IMA）的“高位结扎”。然而，IMA 结扎会影响吻合口的血流，从而增加漏诊率。因此，一些外科医生采用在 IMA 周围进行淋巴结（LN）解剖的技术，保留 IMA 和左结肠动脉（LCA）。由于技术难度，该技术在腹腔镜手术中报告需要更长的时间。我们在此介绍一种简单且安全的腹腔镜IMA 周围 LN 解剖方法，该方法允许保留 IMA 和 LCA，并报告手术结果。
我们的方法涉及从 IMA 上剥离血管鞘，并与鞘一起解剖 IMA 周围的 LN。我们在 72 例连续的乙状结肠和直肠腹腔镜切除术病例中评估了该技术的可行性。
27 例（高位结扎，A 组）在根部结扎 IMA。21 例（B 组）在保留 IMA 和 LCA 的情况下解剖 IMA 周围的 LN。Tis 和 T1N0 病例（低位结扎，C 组）结扎直肠上动脉根部 24 例。A、B 和 C 组的平均手术时间分别为 207.6、221.2 和 198.5 分钟。相应的出血量分别为 47.8、44.0 和 58.5 g，平均采集的 LN 数量分别为 17.3、16.3 和 10.7。A 组和 B 组的手术结果在统计学上无差异。LN 解剖与任何发病率均无关。
我们的方法允许在不增加手术时间或出血的情况下进行与高位结扎技术相当的腹腔镜淋巴结解剖。
