Francone Elisa, Bonfante Pierfrancesco, Bruno Maria Santina, Intersimone Donatella, Falco Emilio, Berti Stefano
Department of Surgery, S. Andrea Hospital, POLL-ASL5, Via Vittorio Veneto 197, 19100, La Spezia, Italy.
Department of Pathological Anatomy, S. Andrea Hospital, POLL-ASL5, Via Vittorio Veneto 197, 19100, La Spezia, Italy.
World J Surg. 2016 Nov;40(11):2790-2795. doi: 10.1007/s00268-016-3611-1.
In sigmoid cancer, both inferior mesenteric artery high or low ligations are accepted for curative purposes. Since inferior mesenteric artery ligation could compromise blood flow to the anastomosis, potentially increasing anastomotic leakage onset, real oncological benefits and possible disadvantages related to vascular transection level are still on debate. We introduce totally laparoscopic inferior mesenteric artery peeling technique to release from the concept of lymph nodal harvesting linked to arterial transection level.
Over a period of 24 months, 31 patients presenting with sigmoid cancer were submitted to laparoscopic sigmoidectomy associated with inferior mesenteric artery peeling. Data on intraoperative and postoperative outcomes have been prospectively collected.
Mean operative time was 180 min (range 110-330 min); mean intraoperative blood loss was 60 ml (range 30-150 ml), and mean postoperative hospitalization was 6.2 days (range 4-11 days). Mean number of lymph node harvested was 16.7 (range 12-28).
Given a proper selection of patients, laparoscopic sigmoidectomy comprehensive of sub-adventitial IMA skeletonization from its aortic origin could provide good oncological outcomes and recanalization rate. Further data are advocated to confirm these preliminary results.
在乙状结肠癌中，肠系膜下动脉高位或低位结扎均可用于根治目的。由于肠系膜下动脉结扎可能会影响吻合口的血流，潜在地增加吻合口漏的发生率，因此与血管切断水平相关的真正肿瘤学益处和可能的缺点仍存在争议。我们引入了完全腹腔镜下肠系膜下动脉剥离技术，以摆脱与动脉切断水平相关的淋巴结清扫概念。
在24个月的时间里，31例乙状结肠癌患者接受了腹腔镜乙状结肠切除术并进行了肠系膜下动脉剥离。前瞻性收集了术中及术后结果的数据。
平均手术时间为180分钟（范围110 - 330分钟）；平均术中失血量为60毫升（范围30 - 150毫升），平均术后住院时间为6.2天（范围4 - 11天）。平均淋巴结清扫数量为16.7个（范围12 - 28个）。
在适当选择患者的情况下，从主动脉起始处对肠系膜下动脉进行外膜下骨骼化的腹腔镜乙状结肠切除术可提供良好的肿瘤学结果和再通率。提倡进一步的数据来证实这些初步结果。
