腹腔镜保留左结肠动脉直肠癌根治术的研究进展
Research Progress of Preserving Left Colon Artery during Laparoscopic Radical Resection of Rectal Cancer
DOI: 10.12677/ACM.2022.124524, PDF,    科研立项经费支持
作者: 陈日龙, 唐云昊, 张剑波, 李 潼, 朱 鹏*：重庆医科大学附属第二医院胃肠肛肠外科，重庆
关键词: 直肠癌；左结肠动脉；肠系膜下动脉；Riolan弓；吻合口瘘；Rectal Cancer； Left Colon Artery； Inferior Mesenteric Artery； Riolan Arch； Anastomotic Leakage
摘要: 直肠癌作为常见消化道肿瘤之一，其发生率逐年增加，手术治疗仍是目前治疗直肠癌的主要方式，因此规范而有效的手术治疗是直肠癌治疗的关键，手术中对肠系膜下动脉的处理是低位直肠癌手术的关键步骤之一，其中保留左结肠动脉(LCA)直肠癌根治术已被广大外科医师接受，但根据目前研究显示其是否降低吻合口并发症，能否确保肿瘤疗效及其中的内在原因等方面仍存在争议。本文拟对目前保留左结肠直肠癌根治术相关研究进展进行综述，以期术式的规范及认识。
Abstract: As one of the common gastrointestinal tumors, the incidence of rectal cancer is increasing year by year. Surgical treatment is still the main way to treat rectal cancer. Therefore, standardized and effective surgical treatment is the key to the treatment of rectal cancer, and the management of the inferior mesenteric artery is one of the key steps of low rectal cancer surgery. Preserving the left colic artery during radical resection of rectal carcinoma has been accepted by the majority of surgeons. However, according to current studies, whether preservation of LCA can reduce anas-tomotic complications and ensure tumor efficacy and its internal causes are still controversial. In this article, the current research progress of radical resection of left colorectal cancer was reviewed in order to standardize and cognize the surgical methods.
文章引用：陈日龙, 唐云昊, 张剑波, 李潼, 朱鹏. 腹腔镜保留左结肠动脉直肠癌根治术的研究进展[J]. 临床医学进展, 2022, 12(4): 3616-3621. https://doi.org/10.12677/ACM.2022.124524

参考文献

[1] Siegel, R.L., Miller, K.D., Fuchs, H. and Jemal, A. (2021) Cancer Statistics, 2021. CA: A Cancer Journal for Clinicians, 71, 7-33. [Google Scholar] [CrossRef] [PubMed]
[2] Chen, W., Zheng, R., Baade, P.D., Zhang, S., Zeng, H., Bray, F., et al. (2016) Cancer statistics in China, 2015. CA: A Cancer Journal for Clinicians, 66, 115-132. [Google Scholar] [CrossRef] [PubMed]
[3] Watanabe, T., et al. (2018) Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2016 for the Treatment of Colorectal Cancer. International Journal of Clinical Oncology, 23, 1-34. [Google Scholar] [CrossRef] [PubMed]
[4] Zhang, C., Wei, H.T., Hu, W., Sun, Y., Zhang, Q., Abe, M., et al. (2020) The Feasibility of Laparoscopic TSME Preserving the Left Colic Artery and Superior Rectal Artery for Upper Rectal Cancer. World Journal of Surgical Oncology, 18, 1-34. [Google Scholar] [CrossRef] [PubMed]
[5] 张鲁阳, 臧潞, 马君俊, 董峰, 何子锐, 郑民华. 腹腔镜直肠癌根治术中保留左结肠动脉的临床意义[J]. 中华胃肠外科杂志, 2016, 19(8): 886-891.
[6] Mari, G.M., Crippa, J., Cocozza, E., Berselli, M., Livraghi, L., Carzaniga, P., et al. (2019) Low Ligation of Inferior Mesenteric Artery in Laparoscopic Anterior Resection for Rectal Cancer Reduces Genitourinary Dysfunction: Results From a Randomized Controlled Trial (HIGHLOW Trial). Annals of Surgery, 269, 1018-1024. [Google Scholar] [CrossRef] 
[7] 郁宝铭. 对直肠癌划分高位、中位、低位和超低位临床意义的再认识[J]. 中华胃肠外科杂志, 2011, 14(10): 821-822.
[8] 李道娟, 李倩, 贺宇彤. 结直肠癌流行病学趋势[J]. 肿瘤防治研究, 2015, 42(3): 305-310.
[9] 武颖超, 汪欣, 刘玉村, 万远廉, 黄珊君. 直肠癌肠系膜下动脉根部淋巴结转移规律的研究[J]. 中华普通外科杂志, 2013, 28(8): 586-589.
[10] 李心翔, 李清国. 腹腔镜直肠癌术中左结肠动脉保留的意义[J]. 中华胃肠外科杂志, 2018, 21(3): 272-275.
[11] 张琪, 孙枢文, 吴晓清, 王道荣. 直肠癌根治术中肠系膜下动脉处理方式研究进展[J]. 中国实用外科杂志, 2018, 38(10): 1193-1196.
[12] 沈海玉, 刘正, 梅世文, 陈佳楠, 李娟, 王治杰, 等. 基于CT血管造影和血管三维重建技术的肠系膜下动脉及分支临床解剖学研究[J]. 中华结直肠疾病电子杂志, 2021, 10(3): 284-290.
[13] Lange, J.F., Komen, N., Akkerman, G., Nout, E., Horstmanshoff, H., Schlesinger, F., et al. (2007) Riolan’s Arch: Confusing, Misnomer, and Obsolete. A Literature Survey of the Connection(s) between the Superior and Inferior Mesenteric Arteries. American journal of surgery, 193, 742-748. [Google Scholar] [CrossRef] [PubMed]
[14] Park, H., Piozzi, G.N., Lee, T.H., Kim, J.S., Choi, H.B. and Kim, S.H. (2020) Arc of Riolan-Dominant Colonic Perfusion Identified by Indocyanine Green after High Li-gation of Inferior Mesenteric Artery: Critical in Preventing Anastomotic Ischemia. Diseases of the Colon & Rectum, 64, Article No. e64. [Google Scholar] [CrossRef] 
[15] 李俊, 安勇博, 吴国聪, 赵晓牧, 杨盈赤, 王今, 等. 直肠癌前切除术后吻合口漏的发生率以及影响因素分析[J]. 中华胃肠外科杂志, 2018, 21(4): 413-418.
[16] 冯波, 苏浩. 腹腔镜直肠癌根治术中保留盆自主神经的关键技术与意义[J]. 中华普外科手术学杂志(电子版), 2019, 13(1): 8-12.
[17] 张策, 李国新, 丁自海, 吴涛, 钟世镇. 直肠癌外科与自主神经保留: 肠系膜下动脉结扎的神经解剖因素[J]. 南方医科大学学报, 2006, 26(1): 49-52.
[18] 周东旭, 邓洋, 李兆朋, 郝朗松. 直肠癌根治术保留左结肠动脉的疗效评价与Meta分析[J]. 安徽医药, 2020, 24(8): 1485-1493.
[19] Bae, S.U., Baek, S.J., Hur, H., Baik, S.H., Kim, N.K. and Min, B.S. (2013) Intraoperative Near Infrared Fluorescence Imaging in Robotic Low Anterior Resection: Three Case Reports. Yonsei Medical Journal, 54, 1066-1069.
[20] Chin, C., Yeh, C.Y., Tang, R., Changchien, C.R., Huang, W.S. and Wang, J.Y. (2008) The Oncologic Benefit of High Ligation of the Inferior Mesen-teric Artery in the Surgical Treatment of Rectal or Sigmoid Colon Cancer. International Journal of Colorectal Disease, 23, 783-788. [Google Scholar] [CrossRef] [PubMed]
[21] Cirocchi, R., Trastulli, S., Farinella, E., Desiderio, J., Vettoretto, N., Parisi, A., et al. (2012) High Tie versus Low Tie of the Inferior Mesenteric Artery in Colorectal Cancer: A RCT Is Needed. Surgical Oncology, 21, e111-e123. [Google Scholar] [CrossRef] [PubMed]
[22] Ke, J., Cai, J., Wen, X., Wu, X., He, Z., Zou, Y., et al. (2017) Anatomic Variations of Inferior Mesenteric Artery and Left Colic Artery Evaluated by 3-Dimensional CT Angiography: Insights into Rectal Cancer Surgery—A Retrospective Observational Study. International Journal of Surgery, 41, 106-111. [Google Scholar] [CrossRef] [PubMed]
[23] Sekimoto, M., Takemasa, I., Mizushima, T., Ikeda, M., Yamamoto, H., Doki, Y., et al. (2011) Laparoscopic Lymph Node Dissection around the Inferior Mesenteric Artery with Preservation of the Left Colic Artery. Surgical Endoscopy, 25, 861-866. [Google Scholar] [CrossRef] [PubMed]
[24] 保留左结肠动脉的直肠癌根治术中国专家共识编审委员会, 中国医师协会肛肠医师分会大肠癌综合治疗组与中西医结合学会普通外科专业委员会直肠癌防治专家委员会. 保留左结肠动脉的直肠癌根治术中国专家共识(2021版) [J]. 中华胃肠外科杂志, 2021, 24(11): 950-955.
[25] 陈佳佳, 陈志安, 郭伟毅, 肖晴, 邓汉闻, 李严兵, 等. 基于CT图像应用Mimics软件的三维重建技术在腹腔镜直肠癌D3根治术中的价值[J]. 中国医学物理学杂志, 2019, 36(7): 778-783.
[26] 尤小兰, 王元杰, 程之逸, 李文琦, 徐宁, 刘贵远, 等. 腹腔镜直肠癌全直肠系膜切除术中保留左结肠动脉的临床研究[J]. 中华胃肠外科杂志, 2017, 20(10): 1162-1167.
[27] 伍颖君, 李民. 保留左结肠动脉应用于腹腔镜低位直肠前切除术的临床研究[J]. 中华胃肠外科杂志, 2017, 20(11): 1313-1315.

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