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保留左结肠动脉的腹腔镜直肠癌根治术:解剖学基础与手术经验

[Laparoscopic radical resection of rectal cancer with preservation of the left colic artery: anatomical basis and surgical experience].

作者信息

Zhong M, Luo Y, Yu M H

机构信息

Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2020 Aug 1;58(8):600-603. doi: 10.3760/cma.j.cn112139-20200325-00252.

Abstract

In order to increase the blood supply of anastomosis, surgeons choose to preserve the left colon artery (LCA) during the laparoscopic radical resection of rectal cancer. However, surgeons are always ailed by hemorrhage and incompletely dissection of No. 253 lymph nodes. One reason is the shortage of understanding the relationship between inferior mesenteric artery (IMA), LCA, and inferior mesenteric vein before surgery. Another reason is that surgeon always remove the lymph nodes around LCA, while don't normatively resect No. 253 lymph nodes, which affect the overall survival rate. Therefore, the "medial-to-lateral approach" for laparoscopic preservation with LCA radical resection in rectal cancer was suggested in this article. The CT technique could be used to analyze the IMA classification, which contribuated to the standard conservation of LCA. Laparoscopic radical resection of rectal cancer could be completed of high quality, through accurate definition and exactly dissection of the No. 235 lymph nodes.

摘要

为了增加吻合口的血供,外科医生在腹腔镜直肠癌根治术中选择保留左结肠动脉(LCA)。然而,外科医生一直受出血和253组淋巴结清扫不彻底的困扰。一个原因是术前对肠系膜下动脉(IMA)、LCA和肠系膜下静脉之间关系的认识不足。另一个原因是外科医生总是切除LCA周围的淋巴结,而没有规范地切除253组淋巴结,这影响了总体生存率。因此,本文提出了腹腔镜保留LCA直肠癌根治术的“由内向外入路”。CT技术可用于分析IMA分型,这有助于LCA的标准化保留。通过准确界定和精确清扫235组淋巴结,可高质量地完成腹腔镜直肠癌根治术。

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