Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery
Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery
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DOI：
10.23922/jarc.2019-016
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发表时间：
2019-10-01
影响因子：
1.4
通讯作者：
Kono, Koji
中科院分区：
文献类型：
--
作者：
Sakamoto, Wataru;Yamada, Leo;Kono, Koji
目的：保留左结肠动脉的肠系膜下动脉（IMA）周围淋巴结清扫术是直肠癌手术的标准手术。尽管IMA鞘是众所周知的结构，但据我们所知，还没有从肿瘤学角度描述其显微解剖结构的报道；因此，对于如何处理鞘管以准确切除 IMA 周围的淋巴结尚无共识。我们的目的是从病理学角度研究 IMA 鞘的组成部分，特别关注淋巴结 (LN) 和淋巴管 (LD) 的存在。方法：对2017年4月-2018年4月在我院采用高扎技术切除的直肠癌和乙状结肠癌标本进行评价。标本连续采集，不进行任何选择。在切除的标本中，研究了 IMA 的整个解剖结构。我们将 IMA 鞘定义为位于 IMA 外膜表面和连接最外层神经纤维的胶原层之间的组织。使用 H&E 染色检查 IMA 周围的显微解剖结构，并使用 D2-40 免疫组织化学鉴定 LD。结果：20 名患者入组。在所有病例中均未在鞘内观察到 LN。然而，鞘内存在大量 LD (11.08 +/- 3.35)。结论：我们对 IMA 鞘管的解剖学定义是可行的并且客观上是可能的。这些显微解剖结果部分支持左结肠动脉保留 IMA 周围淋巴结清扫的手术概念。如果不去除 IMA 本身，可能很难去除所有淋巴管。
Objectives: Left colic artery preserving lymph node dissection around the inferior mesenteric artery (IMA) is a standard procedure for rectal cancer surgery. Although the IMA sheath is a well-known structure, to our knowledge, there are no reports describing its microanatomy from an oncological point of view; therefore, there is no consensus on how to handle the sheath for accurate lymph node dissection around IMA. We aimed to investigate the components of the IMA sheath pathologically, focusing particularly on the presence of lymph nodes (LNs) and lymphatic ducts (LDs). Methods: We evaluated rectal and sigmoid cancer specimens resected with high-tie technique in our institute in April 2017-April 2018. The specimens were collected consecutively, without any selection. In the resected specimens, the entire anatomical structure of IMA was investigated. We defined the IMA sheath as the tissues located between the surface of the IMA adventitia and collagenous layers connecting the outermost nerve fibers. The microanatomy around the IMA was examined using H&E staining, and LDs were identified using D2-40 immunohistochemistry. Results: Twenty patients were enrolled. No LNs were observed within the sheath in any of the cases. However, there were a significant number of LDs (11.08 +/- 3.35) within the sheath. Conclusions: Our anatomical definition of IMA sheath was feasible and objectively possible. These microanatomical results partially support the surgical concept of left colic artery preserving lymph node dissection around the IMA. It may be difficult to remove all lymphatic ducts without removing the IMA itself.