【摘要】 目的:探讨动脉先行法在腹腔镜保留左结肠动脉（LCA）的直肠癌根治术中的应用价值。方法:回顾性分析2016年3月—2018年2月采用动脉先行法的腹腔镜辅助保留LCA直肠癌根治性前切除术32例患者的临床资料,总结其优缺点。操作要点:血管鞘内游离肠系膜下动脉（IMA）及其分支,于根部离断直肠上动脉、乙状结肠动脉,适当的位置离断肠系膜下静脉,将保留的IMA-LCA血管袢提起牵向头侧,排除血管干扰,完全暴露并清除253组淋巴结。结果:32例患者平均手术时间170（130～280）min;平均术中出血35（20～100）m L。术中无输尿管损伤。术后无吻合口瘘及腹腔出血等并发症。253组淋巴结清除4.2（2～8）枚。术后病理诊断:高分化腺癌8例,中分化腺癌17例,低分化腺癌7例;IMA根部淋巴结均为阴性。按照TNM分期,T₁为6例,T₂为7例,T₃为19例;N₀为16例,N₁为9例,N₂为7例;Ⅰ期5例、Ⅱ期11例、Ⅲ期16例。结论:在腹腔镜辅助保留LCA的直肠癌根治性前切除手术中,先行打开血管鞘游离IMA及其分支,反转牵开保留的IMA-LCA血管袢,易于彻底清除IMA根部淋巴结,保留LCA降低了吻合口瘘的发生。采用动脉先行法保留LCA的腹腔镜辅助直肠癌前切除术安全可靠,简单易行。更多还原

【Abstract】 Objective:To evaluate the feasibility and efficacy of artery-first approach in laparoscopic anterior resection of rectal cancer with preservation of the left colonic artery（LCA）.Method:From March 2016 to February 2018,32 patients with rectal cancer received laparoscopic anterior resection.The inferior mesenteric artery（IMA）and the branches were first dissected out from vascular sheath,The LCA was preserved by transecting the IMA inferior to the LCA.The preserved IMA-LCA loop was turned over to head side of the mesentery.Exclude the influence of the IMA-LCA,the lymph nodes in the base of IMA were en bloc resected.Result:The operative time ranged from 130 to 280 min,with a mean of 170 min.The mean intraoperative hemorrhage was 35m L（20 to 100 m L）.None of the patients had injuries to blood vessel,ureter or adjacent organs.None of the patients had postoperative intra-abdominal hemorrhage or anastomosis leakage.The number of dissected lymph nodes surrounding the IMA ranged from 2 to 8,with a mean of 4.2.The postoperative pathological outcomes showed 8 cases of highly differentiated adenocarcinoma,17 cases of moderately differentiated adenocarcinoma,and 7 cases of poorly differentiated adenocarcinoma.According to TNM classification:T₁6 cases;T₂7 cases;T₃19 cases.N₀16 cases;N₁9 cases;N₂7 cases;StageⅠ,5 cases;StageⅡ,11 cases;StageⅢ,16 cases.The dissected lymph nodes in the base of the IMA showed no metastasis.Conclusion:In laparoscopic anterior resection of recta cancer with LCA preserved by artery-first approach,Arterial free first from the sheath can reveal I-MA and its branches more clearly,which is conducive to thorough dissection of lymph nodes around IMA.Artery-first approach for laparoscopic anterior resection of rectal ancer with preservation of the LCA is safe and feasible.更多还原