直肠癌腹腔镜保留左结肠动脉根治术中肠系膜下动脉分型的临床研究。
A clinical study of inferior mesenteric artery typing in laparoscopic radical resections with left colonic artery preservation of rectal cancer.
机构信息
Department of Radiology, Affiliated Hospital 2 of Nantong University, No.6 Hai Er Xiang North Road, Nantong, 226001, Jiangsu Province, China.
Department of Radiology, Affiliated Hospital of Nantong University, Nantong, 226006, Jiangsu Province, China.
出版信息
World J Surg Oncol. 2022 Sep 12;20(1):292. doi: 10.1186/s12957-022-02762-4.
OBJECTIVES
An investigation of the effects of different types of the inferior mesenteric artery (IMA) on laparoscopic left colic artery (LCA) radical resection of rectal cancer was conducted.
METHODS
Clinical data were collected from 92 patients who underwent laparoscopic radical resection of rectal cancer with preservation of the LCA at Nantong University's Second Affiliated Hospital. All patients underwent full-abdominal dual-energy CT enhancement examination before surgery and 3D post-processing reconstruction of the IMA. Two radiologists with >3 years of experience in abdominal radiology jointly conducted the examination. A total of three types of IMA were identified among the patients: IMA type I (the LCA arising independently from the IMA), type II (LCA and sigmoid colon artery [SA] branching from a common trunk from IMA), and type III (LCA, SA, and superior rectal artery [SRA] branching from the IMA at the same point). The baseline data, pathological results, and intra-operative and post-operative indicators of the groups were analyzed.
RESULTS
The proportions of type I, type II, and type III IMA were 58.70% (54/92), 18.48% (17/92), and 22.82% (21/92), respectively. IMA typing was consistent with the preoperative CT evaluation results. The intra-operative blood loss of type III IMA patients [median (interquartile spacing), M (P25, P75): 52.00 (39.50, 68.50) ml] was higher than that of type I and II IMA patients [35.00 (24.00, 42.00) and 32.00 (25.50, 39.50) ml, respectively] (P<0.05). The incidence of anastomotic fistula in type III IMA patients (4 cases, 19.05%) was higher than that in non-type III IMA patients (1 case, 1.41%) (X=6.679, P=0.010). The incidence of postoperative complications among the three types of IMA was not significantly different (P>0.05).
CONCLUSIONS
Among rectal cancer patients undergoing laparoscopic LCA preservation, type III IMA patients had more intraoperative bleeding and a higher incidence of postoperative anastomotic fistula. However, this did not increase the risk of overall postoperative complications.
目的
探讨不同类型肠系膜下动脉（IMA）对腹腔镜左结肠动脉（LCA）直肠癌根治性切除术的影响。
方法
收集南通大学第二附属医院 92 例行腹腔镜直肠癌保肛根治术患者的临床资料，所有患者术前均行全腹部双能量 CT 增强检查及 IMA 三维后处理重建，由 2 名具有 3 年以上腹部影像学经验的放射科医生共同阅片，共识别出 3 种 IMA 类型：IMA 型 I（LCA 独立发自 IMA）、IMA 型 II（LCA 和乙状结肠动脉[SIGMA]发自 IMA 的共同干）和 IMA 型 III（LCA、SIGMA 和直肠上动脉[SRA]发自 IMA 同一部位）。分析各组患者的基线资料、病理结果及术中、术后指标。
结果
IMA 型 I、IMA 型 II 和 IMA 型 III 的比例分别为 58.70%（54/92）、18.48%（17/92）和 22.82%（21/92）。IMA 分型与术前 CT 评估结果一致。IMA 型 III 患者术中出血量[中位数（四分位间距），M（P25，P75）：52.00（39.50，68.50）ml]高于 IMA 型 I 和 IMA 型 II 患者[35.00（24.00，42.00）和 32.00（25.50，39.50）ml]（P<0.05）。IMA 型 III 患者吻合口瘘的发生率（4 例，19.05%）高于非 IMA 型 III 患者（1 例，1.41%）（X=6.679，P=0.010）。三种 IMA 类型患者术后并发症发生率差异无统计学意义（P>0.05）。
结论
在接受腹腔镜 LCA 保肛的直肠癌患者中，IMA 型 III 患者术中出血较多，术后吻合口瘘发生率较高，但并未增加总体术后并发症的风险。
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