Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery
Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery
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DOI：
10.1007/s00384-006-0221-7
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发表时间：
2007-06-01
影响因子：
2.8
通讯作者：
Miyazaki, Masaru
中科院分区：
文献类型：
--
作者：
Seike, Kazuhiro;Koda, Keiji;Miyazaki, Masaru
目的 本研究的目的是评估分离肠系膜下动脉（IMA）和保留左结肠动脉（LCA）对直肠乙状结肠癌手术的影响。 患者和方法 采用激光多普勒血流仪对 96 例直肠和乙状结肠癌患者在夹闭 IMA 或 LCA 的情况下测量吻合口近端部位的结肠血流。结果对患者特征和术后并发症进行分析。结果IMA或LCA钳夹均显着降低血流量，其降低率分别为38.5±1.8%（0～82.8%）或16.4±1.8%（0～66.2%）。对于多变量分析，衰老和男性性别是 IMA 钳夹导致高血流量减少的预测因素。男性患者的减少率与年龄显着相关，而女性患者则没有观察到这种相关性。男性的衰老相关性在超低位前切除病例中更为显着。 19 名患者中，有 3 名老年男性患者接受了 IMA 高位结扎术，通过 IMA 钳夹，血流量减少了 50% 以上。其中，2例接受超低位前切除术的患者出现严重的吻合口缺血。结论无论是IMA还是LCA钳夹，吻合口近端结肠血流量均显着减少。通过 IMA 钳夹进行高度复位的患者需要术中努力防止吻合口缺血，特别是接受超低位前切除术的老年男性患者。
Aims The aim of this study is to evaluate the influence of dividing the inferior mesenteric artery (IMA) and preserving the left colic artery (LCA) on rectosigmoid cancer surgery.Patients and methods Colonic blood flow at the proximal site of the anastomosis was measured by laser Doppler flowmetry in 96 patients with cancer of the rectum and sigmoid colon while clamping IMA or LCA. Results were analyzed with patient characteristics and postoperative complications.Results Blood flow was significantly decreased by either IMA or LCA clamping, and its reduction rate was 38.5 +/- 1.8%, ranged from 0 to 82.8%, or 16.4 +/- 1.8%, ranged from 0 to 66.2%, respectively. For multivariate analyses, aging and male gender were predictive factors of high blood flow reduction by IMA clamping. The reduction rate was significantly correlated with aging in male patients, while no such correlation was observed in women. Aging correlation in men was more significant in ultralow anterior resection cases. Three elderly male patients received IMA high ligation among 19 patients who demonstrated more than 50% blood flow reduction by IMA clamping. Among these, two patients, those who underwent ultralow anterior resection, suffered severe anastomotic ischemia.Conclusions Colonic blood flow at the proximal site of the anastomosis was significantly decreased by either IMA or LCA clamping. Patients with high reduction by IMA clamping need intraoperative efforts to prevent anastomotic ischemia, particularly in elderly male patients who undergo ultralow anterior resection.