Hall N R, Finan P J, Stephenson B M, Lowndes R H, Young H L
Department of Surgery, General Infirmary at Leeds, UK.
Int J Colorectal Dis. 1995;10(1):29-32. doi: 10.1007/BF00337583.
Division of the inferior mesenteric artery flush with the aorta (high tie) allows a tension-free anastomosis in distal colorectal resections but may also diminish the blood supply. Tissue oxygen tension was measured proximal to the resection margin before and after either low or high division of the inferior mesenteric artery in 62 patients undergoing elective colorectal resections. Oxygenation was maintained or improved when the transverse (median change after vs before resection for low tie +9 mmHg (P < 0.05), high tie +8 mmHg (P = 0.3)) and descending colon (low tie +7 mmHg (p < 0.01), high tie +1 mmHg (p = 0.67)) were used for the anastomosis but diminished for sigmoid anastomoses (low tie -4 mmHg (P = 0.42), high tie -9 mmHg (P < 0.05)). Change in oxygenation was significantly affected by location of proximal resection site but not by choice of high or low tie. These results suggest that the marginal artery provides a more than adequate vascular supply to the transverse and descending colon, but that the sigmoid colon is not suitable for anastomosis. We conclude that the sigmoid colon be sacrificed and there should be no hesitation in performing a high tie to avoid tension in low pelvic anastomoses.
肠系膜下动脉在与主动脉平齐处离断（高位结扎）可使低位结直肠切除术中的吻合无张力，但也可能减少血供。在62例行择期结直肠切除术的患者中，测量了肠系膜下动脉低位或高位离断前后切除边缘近端的组织氧张力。当吻合采用横结肠（低位结扎切除后与切除前的中位变化为+9 mmHg（P < 0.05），高位结扎为+8 mmHg（P = 0.3））和降结肠（低位结扎+7 mmHg（p < 0.01），高位结扎+1 mmHg（p = 0.67））时，氧合得以维持或改善，但乙状结肠吻合时氧合降低（低位结扎-4 mmHg（P = 0.42），高位结扎-9 mmHg（P < 0.05））。氧合变化受近端切除部位的位置显著影响，但不受高位或低位结扎选择的影响。这些结果表明，边缘动脉为横结肠和降结肠提供了足够的血管供应，但乙状结肠不适合吻合。我们得出结论，应牺牲乙状结肠，在进行高位结扎以避免低位盆腔吻合处张力时不应犹豫。
