左结肠动脉的保留对TaTME (经肛全直肠系膜切除术)并发症的影响

The Impact of Left Colic Artery Preservation on Complications of TaTME (Transanal Total Mesorectal Excision)

摘要: 左结肠动脉(LCA)保留作为经肛全直肠系膜切除术(TaTME)的核心争议，近年来受到广泛关注。本文系统综述了LCA保留对TaTME术后并发症及肿瘤学结局的影响。解剖学研究表明，LCA通过边缘动脉弓为直肠远端提供侧支血供，其保留可显著改善吻合口氧合及微循环灌注，尤其在新辅助放疗后组织纤维化的患者中优势更显著。临床证据显示，LCA保留组吻合口漏发生率较高位结扎组降低，且糖尿病、肥胖及代谢综合征患者获益更明显。亚组分析表明，低位吻合(<5 cm)患者中，LCA保留通过降低吻合口张力使术后并发症风险减少。肿瘤学方面，保留LCA未显著影响淋巴结清扫总数及阳性率，长期生存数据(亦无统计学差异。本综述基于现有研究，聚焦争议焦点(肿瘤根治性平衡)，对进行TaTME手术的直肠癌患者其个体化手术策略的定制和改良提供参考。

Abstract: The preservation of left colonic artery (LCA), as the core controversy of transanal total mesorectal excision (TaTME), has been widely concerned in recent years. In this paper, the effects of LCA preservation on postoperative complications and oncology outcome of TaTME were systematically reviewed. Anatomical research shows that LCA provides collateral blood supply to the distal rectum through the marginal arterial arch, and its retention can significantly improve anastomosis oxygenation and microcirculation perfusion, especially in patients with tissue fibrosis after neoadjuvant radiotherapy. Clinical evidence shows that the incidence of anastomotic leakage in LCA retention group is lower than that in high ligation group, and patients with diabetes, obesity and metabolic syndrome benefit more obviously. Subgroup analysis showed that in patients with low anastomosis (<5 cm), LCA preservation reduces the risk of postoperative complications by reducing anastomotic tension. In oncology, preserving LCA did not significantly affect the total number of lymph node dissection and positive rate, and the long-term survival data (no statistical difference. Based on the existing research, this review focuses on the controversial focus (radical balance of tumor), and provides reference for the customization and improvement of individualized surgical strategies for rectal cancer patients undergoing TaTME surgery.