远端乙状结肠癌的面向血管的D3淋巴结清除术：多种技术
Vascular-oriented D3 lymph node dissection with left colic artery preservation for distal sigmoid colon cancer: a variety of techniques
影响因子:2.90000
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
摘要
远端Sigmoid结肠癌手术治疗的方法之一是分段结肠切除，血管保存左绞痛（LCA）。 D3淋巴结清扫术在技术上可能会根据不同的血管解剖结构而变化。这项研究的目的是根据不同的下肠系膜动脉（IMA）分支的不同模式来证明D3淋巴结清扫术和LCA保存的D3淋巴结清除术，以识别IMA分支模式。在所有情况下，都以标准化的方式进行了腹腔镜远端乙状结肠切除术，并以D3淋巴结清除术和左绞痛保持。数据，包括临床，术中和短期手术结果，以中位数（ME）和四分位数（IQR）（IQR）为中位数。二十六名患有远端乙状结肠结肠癌的患者用腹腔镜远端远端sigmoid结肠切除治疗。 D3淋巴结清扫术的方法根据不同的解剖变异而变化。高BMI患者有一种转化率（3.8％）和一个吻合泄漏（3.8％）。同时，由于IMA的骨骼化，有一个高顶淋巴结计数（Me 3（IQR 2-5），Min-Max 0-10）。D3淋巴结与左绞痛动脉保存的技术方面可能在不同类型的LCA和Sigmoid Artery Branching模式中有所不同，而对标准的landosiss Anatoms Anatomicals Anatoms Anatoms Anatoms Anatoms Anatoms Anatoms Anatomals Anatom anaToms Anatomals Anatomals Anatomals Anatomals Anatomals Anatomals Anatom anaTomals。进行血管释放淋巴结清扫时，应考虑解剖学特征。
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.