直肠癌手术中低位结扎肠系膜下动脉的争议  

Controversy of low ligation of inferior mesenteric artery in rectal cancer surgery

作　　者：陈瑞 姜巍[1] 姜浩[1,2,3] 高峰 CHEN Rui;JIANG Wei;JIANG Hao;GAO Feng(The Second Hospital Affiliated to Harbin Medical University,Heilongjiang Harbin 150086,China;The First Affiliated Hospital of Ningbo University,Zhejiang Ningbo 315020,China;Institute of Digestive Diseases,Ningbo University,Zhejiang Ningbo 315020,China)

机构地区：[1]哈尔滨医科大学附属第二医院,黑龙江哈尔滨150086 [2]宁波大学附属第一医院,浙江宁波315020 [3]宁波大学消化疾病研究所,浙江宁波315020

出　　处：《现代肿瘤医学》2023年第10期1956-1959,共4页Journal of Modern Oncology

基　　金：吴阶平医学基金会(编号:320.6750.18492);黑龙江省高等教育教学改革研究项目(编号:SJGY20200448)。

摘　　要：肠系膜下动脉(inferior mesenteric artery, IMA)的结扎是直肠癌手术中至关重要的一步,但其结扎水平却一直难以达成统一的认识。主要争议点是,关于术中左结肠动脉(left colic artery, LCA)是否保留,其吻合口漏发生率、IMA根部淋巴结(253站淋巴结)清扫、术中神经损伤及术后排便、排尿及性功能的影响等在各研究中心不能达成一致,这就造成了在手术时术者对于手术术式的选择难以形成统一的规范,因此不论对术者或是患者都会产生不同程度的影响。随着腹腔镜辅助下手术技术及高清镜、3D腹腔镜、4K高清镜、显微外科、三维CT血管造影技术的发展,之前术中的一些解剖难题及难以实施的精细手术操作也得到了很大程度的解决和改进,这些都为术者选择更加安全合理可行的术式提供了支撑。Ligation of the inferior mesenteric artery(IMA)is an important step in rectal cancer surgery,but the level of ligation has been difficult to reach a consensus.The main points of controversy are whether the left colic artery(LCA)should be preserved intraoperatie,and the incidence of anastomotic leakage,IMA root lymph node dissection(lymph node at site 253),intraoperative nerve injury,and the influence of postoperative defecation,urination,and sexual function cannot be agreed among different research centers.During the operation,it is difficult for the surgeon to form a unified standard for the choice of surgical operation,so it will have different degrees of influence on the surgeon and the patient.With the development of laparoscopic assisted surgery technology and high-definition mirror,3D laparoscope,4K high-definition mirror,microsurgery and 3D CT angiograms,some anatomical problems and difficult fine surgical operations have also been solved and improved to a great extent,which provide support for operators to choose a safer,reasonable and feasible operation.

关 键 词：肠系膜下动脉 肠系膜下动脉根部淋巴结 左结肠动脉 吻合口漏 

分 类 号：R735.3[医药卫生—肿瘤]