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首页> 外文期刊>Surgical Endoscopy >Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery.
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Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery.

机译：腹腔镜在肠系膜下动脉周围进行淋巴结清扫术，并保留左结肠动脉。

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AIM: Curative resection of sigmoid and rectal cancer includes "high tie" of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the leakage rate. Accordingly, some surgeons employ a technique of lymph node (LN) dissection around the IMA, preserving the IMA and left colic artery (LCA). The same technique was reported to need longer time in laparoscopic surgery due to technical difficulties. We present herein a simple and secure method of laparoscopic LN dissection around the IMA that allows preservation of the IMA and LCA, and report the operative results. METHODS: Our method involves peeling off the vascular sheath from the IMA and dissection of the LN around the IMA together with the sheath. The feasibility of the technique was evaluated in 72 consecutive cases of laparoscopic resection of sigmoid and rectal cancer. RESULTS: The IMA was ligated at its root in 27 cases (high tie, group A). Lymph nodes around the IMA were dissected with preservation of the IMA and LCA in 21 cases (group B). The root of the superior rectal artery was ligated in 24 cases of Tis and T1N0 ("low tie," group C). Mean operative time was 207.6, 221.2, and 198.5 min for group A, B, and C, respectively. Respective blood loss was 47.8, 44.0, and 58.5 g, and mean numbers of harvested LN were 17.3, 16.3, and 10.7. None of the operative results of groups A and B were different statistically. LN dissection was not associated with any morbidity. CONCLUSION: Our method allows equivalent laparoscopic lymph node dissection to the high tie technique without excessive operative time or bleeding.
机译：目的：乙状结肠癌和直肠癌的根治性切除术包括肠系膜下动脉（IMA）的“高束缚”。但是，IMA结扎会损害吻合口的血流，这可能会增加泄漏率。因此，一些外科医生采用了围绕IMA的淋巴结清扫术，以保留IMA和左结肠动脉（LCA）。据报道，由于技术困难，同一技术在腹腔镜手术中需要更长的时间。我们在本文中介绍了一种围绕IMA进行腹腔镜LN解剖的简单安全的方法，该方法可保存IMA和LCA，并报告手术结果。方法：我们的方法包括从IMA剥离血管鞘，并在IMA周围连同鞘一起解剖LN。在连续72例腹腔镜切除乙状结肠和直肠癌的病例中评估了该技术的可行性。结果：IMA在其根部结扎27例（高结扎，A组）。解剖IMA周围的淋巴结，保留IMA和LCA 21例（B组）。 24例Tis和T1N0结扎了直肠上动脉的根部（“低结扎”，C组）。 A，B和C组的平均手术时间分别为207.6、221.2和198.5分钟。失血量分别为47.8、44.0和58.5 g，平均收获的LN数量为17.3、16.3和10.7。 A组和B组的手术结果均无统计学差异。 LN解剖与任何发病率均无关。结论：我们的方法允许腹腔镜下淋巴结清扫术与高强度结扎术相同，而没有过多的手术时间或出血。

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