血管导向的左结肠动脉保留远端乙状结肠癌D3淋巴结清扫术：多种技术方法
Vascular-oriented D3 lymph node dissection with left colic artery preservation for distal sigmoid colon cancer: a variety of techniques
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影响因子:2.9
分区:医学3区 / 胃肠肝病学3区 外科3区
发表日期:2024 Sep 10
作者:
S K Efetov, A A Zubayraeva, D V Serednyakova, R N Mozharov, R R Saltovets, A Y Koziy
DOI:
10.1007/s10151-024-03003-4
摘要
远端乙状结肠癌手术治疗的途径之一是结肠段切除术，同时保留左结肠动脉（LCA）血管。D3淋巴结清扫在技术上可能因血管解剖结构不同而变化。本研究旨在根据不同的肠系膜上动脉（IMA）分支模式，展示采用LCA保留的D3淋巴结清扫方法。所有病例都常规进行带有3D重建的CT血管造影，以识别IMA的分支模式。所有患者均采用标准化的腹腔镜远端乙状结肠切除术，进行D3淋巴结清扫和左结肠动脉保留。数据，包括临床、手术中及短期手术结局，均以中位数（Me）和四分位距（IQR）表示。共26例远端乙状结肠癌患者接受腹腔镜手术。D3淋巴结清扫的途径因解剖变异不同而异。高BMI患者中有一次转换（3.8%）和一次吻合口漏（3.8%）。同时，由于IMA骨架化，淋巴结数量较多（中位数3（IQR 2-5），范围0-10）。不同LCA和乙状结肠动脉分支模式的血管保护淋巴结清扫技术可能存在差异，而不依赖于标准化的解剖标志。进行血管保留淋巴结清扫时，应考虑解剖特征。
Abstract
One of the approaches to distal sigmoid colon cancer surgical treatment is segmental colonic resection with vascular preservation of left colic artery (LCA). D3 lymph node dissection may technically vary according to different vascular anatomy. This study aims to show the approaches to D3 lymph node dissection with LCA preservation for distal sigmoid colon cancer according to different patterns of inferior mesenteric artery (IMA) branching.CT angiography with 3D reconstruction was routinely performed to identify the IMA branching pattern. Laparoscopic distal sigmoid colon resection with D3 lymph node dissection and left colic artery preservation in standardized fashion was performed in all cases. Data, including clinical, intraoperative, and short-term surgical outcomes, is presented as median numbers (Me) and interquartile range (IQR).Twenty-six patients with distal sigmoid colon cancer were treated with laparoscopic distal sigmoid colon resection. The approach to D3 lymph node dissection varied according to different anatomical variations. There was one conversion (3.8%) and one anastomotic leakage (3.8%) in patients with high BMI. At the same time, there was a high apical lymph node count (Me 3 (IQR 2-5), min-max 0-10) due to the skeletonization of the IMA.The technical aspects of D3 lymph node dissection with left colic artery preservation may vary in different types of LCA and sigmoid artery branching patterns regardless of the standardized anatomical landmarks. The anatomical features should be considered when performing vascular-sparing lymph node dissection.