背景:保留左结肠动脉(LCA)已成为腹腔镜直肠癌根治术的首选方法。然而,保留LCA,同时解剖253号淋巴结可以在肠系膜下动脉(IMA)之间产生肠系膜缺损,LCA,和肠系膜下静脉(IMV)。这种缺陷可能是潜在的疝气环,“增加手术后发生内疝的风险。这项研究的目的是介绍一种新技术,旨在通过用自体组织填充肠系膜缺损来减轻内疝的风险。
方法:这项新技术是在2022年1月至2022年6月期间对18例直肠癌患者进行的。首先,从IMA的起源开始解剖IMA主干上的淋巴脂肪组织,直到暴露LCA和乙状结肠动脉(SA)或直肠上动脉(SRA),然后在IMA之间解剖253号淋巴结,LCA和IMV。接下来,在远离"疝环"的适当位置依次结扎和切断SRA或SRA和IMV,以保护"疝环"和腹膜后之间的结缔组织.最后,远端乙状结肠动员后,在IMV的侧面,降结肠头部动员。患者术前基线特征和术中,检查术后并发症。
结果:使用我们的新技术成功闭合了所有患者的潜在疝环。中位手术时间为195分钟,术中出血量中位数为55ml(四分位距30-90).收集的淋巴结总数为13.0(范围12-19)。首次排气和流质饮食摄入的中位时间均为3.0天。术后住院天数中位数为8.0天。一个病人边缘动脉弓受伤,在脾区域细胞化之后,实现无张力吻合。无其他严重术后并发症如腹腔感染,吻合口漏,或观察到出血。
结论:该技术对于填充肠系膜缺损既安全又有效,在直肠癌手术中,腹腔镜第253号淋巴结清扫术和保留左绞痛动脉后,可能降低内疝的风险。
BACKGROUND: The preservation of the left colic artery (LCA) has emerged as a preferred approach in laparoscopic radical resection for rectal cancer. However, preserving the LCA while simultaneously dissecting the NO.253 lymph node can create a mesenteric defect between the inferior mesenteric artery (IMA), the LCA, and the inferior mesenteric vein (IMV). This defect could act as a potential \"hernia ring,\" increasing the risk of developing an internal hernia after surgery. The objective of this study was to introduce a novel technique designed to mitigate the risk of internal hernia by filling mesenteric defects with autologous tissue.
METHODS: This new technique was performed on eighteen patients with rectal cancer between January 2022 and June 2022. First of all, dissected the lymphatic fatty tissue on the main trunk of IMA from its origin until the LCA and sigmoid artery (SA) or superior rectal artery (SRA) were exposed and then NO.253 lymph node was dissected between the IMA, LCA and IMV. Next, the SRA or SRA and IMV were sequentially ligated and cut off at an appropriate location away from the \"hernia ring\" to preserve the connective tissue between the \"hernia ring\" and retroperitoneum. Finally, after mobilization of distal sigmoid, on the lateral side of IMV, the descending
colon was mobilized cephalad. Patients\'preoperative baseline characteristics and intraoperative, postoperative complications were examined.
RESULTS: All patients\' potential \"hernia rings\" were closed successfully with our new technique. The median operative time was 195 min, and the median intraoperative blood loss was 55 ml (interquartile range 30-90). The total harvested lymph nodes was 13.0(range12-19). The median times to first flatus and liquid diet intake were both 3.0 days. The median number of postoperative hospital days was 8.0 days. One patient had an injury to marginal arterial arch, and after mobolization of splenic region, tension-free anastomosis was achieved. No other severe postoperative complications such as abdominal infection, anastomotic leakage, or bleeding were observed.
CONCLUSIONS: This technique is both safe and effective for filling the mesenteric defect, potentially reducing the risk of internal hernia following laparoscopic NO.253 lymph node dissection and preservation of the left colic artery in rectal cancer surgeries.