Tulina I A, Zhurkovsky V I, Bredikhin M I, Tsugulya P B, Tsarkov P V
Chair of Surgery of the Faculty of Medicine and Prevention of Sechenov First Moscow State Medical University, Moscow, Russia.
Khirurgiia (Mosk). 2018(7):41-46. doi: 10.17116/hirurgia2018741.
To evaluate the results of selective approach for splenic flexure mobilization (SFM) after total mesorectal excision with low colorectal anastomoses.
Clinical data were obtained from the multicenter RCT database comparing ileostomy and colostomy in patients with rectal cancer who underwent total mesorectal excision from 2012 to 2017. Our clinic policy is performing paraaortic lymph node dissection with 'low' inferior mesenteric artery ligation, left colic artery preservation and use of sigmoid colon for colorectal anastomosis. SFM was used only in cases of inability to apply above-mentioned procedure (selective approach for SFM).
SFM was performed in 15 (13%) out of 115 patients. The most frequent reasons for SFM were sigmoid colon diverticulosis, impaired blood supply or inadequate length of sigmoid colon. There were no differences in intraoperative and postoperative complications between TME without SFM and TME with SFM.
Selective SFM in TME followed by advanced paraaortic lymph node dissection and left colic artery preservation is safe and may be considered as a viable option to routine SFM in rectal cancer surgery.
评估低位结直肠吻合的全直肠系膜切除术后脾曲游离（SFM）的选择性方法的效果。
临床数据来自多中心随机对照试验数据库，该数据库比较了2012年至2017年接受全直肠系膜切除术的直肠癌患者的回肠造口术和结肠造口术。我们的临床策略是进行主动脉旁淋巴结清扫，结扎“低位”肠系膜下动脉，保留左结肠动脉，并使用乙状结肠进行结直肠吻合。仅在无法应用上述手术的情况下（SFM的选择性方法）使用SFM。
115例患者中有15例（13%）进行了SFM。SFM最常见的原因是乙状结肠憩室病、血供受损或乙状结肠长度不足。未进行SFM的全直肠系膜切除术（TME）和进行SFM的TME在术中和术后并发症方面没有差异。
在TME中进行选择性SFM，随后进行扩大的主动脉旁淋巴结清扫并保留左结肠动脉是安全的，可被视为直肠癌手术中常规SFM的可行选择。
