Yang Hongjie, Zeng Qingsheng, Zhou Yuanda, Jiang Peishi, Liu Jiafei, Zhang Zhichun, Wang Gangcheng, Sun Yi
Department of Colorectal Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Tianjin, China.
The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.
Ann Surg Oncol. 2025 Sep 5. doi: 10.1245/s10434-025-18224-6.
The ligation of the inferior mesenteric artery (IMA) is the primary procedure during surgeries of the left colon, sigmoid colon, and rectal cancer. Despite the ongoing debate on high or low ligation of the IMA, high ligation (HL) is now preferred by most of the surgeons. However, there is still a lack of consistency in the exact position of HL among surgical videos or introductions presented by different teams, causing confusion to new learners. The fascia-oriented dissection could help to clarify this issue.
This video shows two definite levels of HL, the supra-nerve HL and the infra-nerve HL based on three biological fasciae around the root of the IMA, with priority given to fascia-oriented dissection, HL of the IMA could be performed safely and efficiently, even in cases with enlarged para-IMA nodes.
It is feasible to adopt the fascial space priority approach for HL of the IMA, and this approach is suitable for patients with enlarged para-IMA lymph nodes.
肠系膜下动脉（IMA）结扎是左半结肠、乙状结肠和直肠癌手术中的主要操作。尽管关于IMA高位或低位结扎的争论仍在继续，但现在大多数外科医生更倾向于高位结扎（HL）。然而，不同团队展示的手术视频或介绍中，HL的确切位置仍缺乏一致性，给新学员造成困惑。基于筋膜的解剖有助于阐明这一问题。
本视频展示了基于IMA根部周围三层生物筋膜的两种明确的HL水平，即神经上HL和神经下HL，优先进行基于筋膜的解剖，即使在IMA旁淋巴结肿大的情况下，也能安全、高效地进行IMA的HL。
采用筋膜间隙优先法进行IMA的HL是可行的，且该方法适用于IMA旁淋巴结肿大的患者。
