Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery
Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery
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DOI：
10.1007/s00464-010-1284-7
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发表时间：
2011-03-01
影响因子：
3.1
通讯作者：
Mori, Masaki
中科院分区：
文献类型：
--
作者：
Sekimoto, Mitsugu;Takemasa, Ichiro;Mori, Masaki
乙状结肠癌和直肠癌的根治性切除包括肠系膜下动脉（IMA）的“高位结扎”。然而，IMA结扎会影响吻合口的血流，这可能会增加渗漏率。因此，一些外科医生采用IMA周围淋巴结（LN）清扫技术，保留IMA和左结肠动脉（LCA）。据报告，由于技术困难，相同技术在腹腔镜手术中需要更长时间。我们在此提出一种简单而安全的腹腔镜下分离IMA周围LN的方法，可以保留IMA和LCA，并报告手术结果。我们的方法包括从IMA上剥离血管鞘，并将IMA周围的LN与鞘一起分离。在连续72例乙状结肠癌和直肠癌腹腔镜切除术中评价了该技术的可行性，其中27例（A组，高位结扎）IMA根部。B组21例，切除IMA周围淋巴结，保留IMA和LCA。24例Tis和T1N0患者结扎直肠上级动脉根部（C组）。A、B和C组的平均手术时间分别为207.6、221.2和198.5 min。失血量分别为47.8、44.0和58.5 g，平均收获LN数量分别为17.3、16.3和10.7。A、B两组手术结果无统计学差异。淋巴结清扫术与任何并发症无关，我们的方法可以使腹腔镜淋巴结清扫术等同于高位结扎术，而不会延长手术时间或出血。
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.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.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.Our method allows equivalent laparoscopic lymph node dissection to the high tie technique without excessive operative time or bleeding.