Napolitano A M, Napolitano L, Costantini R, Ucchino S, Innocenti P
Istituto di Patologia Chirurgica, Università degli Studi di Chieti.
G Chir. 1996 Apr;17(4):185-9.
Anastomotic dehiscence after colon resection is the most frequent complication in colon surgery and the main cause of post-operative death. In the light of anatomical peculiarities of the blood supply to the rectum, it would appear that in atherosclerotic patients with impairment of hypogastric arteries (80% in authors' series out of 200 atherosclerotic subjects) inferior mesenteric artery ligature, determining vascularization of the rectal ampulla by the distal vessels alone, results in an insufficient supply in case of colo-rectal anastomosis. A series of 15 cases of cancer of the left and sigmoid colon, treated with left hemicolectomy, preservation and peeling of the inferior mesenteric artery, is reported. In the follow-up ranging from 6 months to 5 years, no anastomotic dehiscence was observed and only one case (7.5%) presented hepatic recurrence after two years. The other patients are all alive and disease free.
结肠切除术后吻合口裂开是结肠手术中最常见的并发症，也是术后死亡的主要原因。鉴于直肠血液供应的解剖学特点，在患有腹下动脉损伤的动脉粥样硬化患者中（作者系列研究的200例动脉粥样硬化患者中有80%），结扎肠系膜下动脉，仅靠远端血管为直肠壶腹供血，在结直肠吻合时会导致供血不足。本文报道了15例左半结肠和乙状结肠癌患者，接受左半结肠切除术，保留并游离肠系膜下动脉。在6个月至5年的随访中，未观察到吻合口裂开，仅1例（7.5%）在两年后出现肝转移。其他患者均存活且无疾病复发。
