腹腔镜辅助直肠癌根治术若干问题探讨  

Discussion on some issues about laparoscopic assisted radical resection of rectal cancer

作　　者：骆洋[1] 俞旻皓[1] 钟鸣[1] LUO yang;YU Min-Hao;ZHONG Ming(Department of Gastrointestinal Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127

出　　处：《中国实用外科杂志》2023年第4期449-452,460,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.81873555);上海市科学技术委员会医学引导类项目(No.19411966200)。

摘　　要：腹腔镜辅助直肠癌根治术在手术入路、淋巴结清扫以及术后吻合口漏等方面尚存在一些认识上的争议和技术难点。根据临床实践,提出建议如下:(1)术前通过腹部CT血管成像判断肠系膜下动脉分型,并采用中间联合头侧入路进行手术,有利于精准化保留左结肠动脉(LCA)。(2)保留LCA过程中须规范化清扫No.253淋巴结。(3)使用“低位直肠癌术后吻合口漏6-321风险评估量表”可准确预测低位直肠癌术后吻合口漏的发生,为术中是否同期行预防性造口提供直接而有利的参考标准。There were still some technical issues,such as surgical approach,and lymphatic dissection,which were still under debate.Based on clinical practice,the following recommendations are proposed:(1)Determine the type of inferior mesenteric artery through abdominal CT angiography before surgery,and use the intermediate combined cephalic approach for surgery,which is conducive to accurate preservation of LCA.(2)Standardized dissection of No.253 lymph nodes is necessary during the preservation of LCA.(3)The use of the"6-321 Risk Assessment Scale for Anastomotic Leakage after Low Rectal Cancer Surgery"can accurately predict the occurrence of anastomotic leakage after low rectal cancer surgery,providing a direct and beneficial reference standard for whether preventive stoma should be performed simultaneously during surgery.

关 键 词：腹腔镜辅助直肠癌根治术 中间联合头侧入路 肠系膜下动脉分型 左结肠动脉 No.253淋巴结 吻合口漏 

分 类 号：R6[医药卫生—外科学]