直肠癌手术高位结扎肠系膜下动脉的争议与意义

Controversy and significance of high ligation of inferior mesenteric artery in the operation of rectal carcinoma

肠系膜下动脉的处理是直肠癌手术的关键步骤之一,但肠系膜下动脉的结扎部位仍存在一定的争议。其争议的焦点在于保留左结肠动脉(LCA)对于肿瘤根治度、吻合口漏发生率、自主神经损伤以及对肠道功能的影响。目前资料显示,保留LCA在保证吻合口血供和促进肠道功能恢复方面均有明显优势。随着3D、4K高清腹腔镜的出现,以及能量平台等各种技术的进步,保留神经和血管的微创手术必将成为未来的发展方向。

Surgery plays a crucial role in treating rectal cancer,and the ligation of the inferior mesenteric artery is one of the many key steps in the operation.In the surgical academia,there is ongoing debate on the ligation site of the inferior mesenteric artery.The key points of the controversy focus on the effects of preserving or removing the left colic artery on tumor recurrence,incidence of anastomotic fistula,damage of autonomic nerve,and intestinal function.The authors summarized both domestic and international articles,reviewed this academic issue,and analyzed the clinical data of the subject.After that,the authors believe that there are obvious advantages of the retention of LCA such as guaranteeing anastomotic blood supply and promoting the recovery of intestinal function.With the development of 3D and 4K high-definition laparoscopy and the advancement of various technologies such as energy platforms and more minimally invasive surgery.The maximal preservation of nerve and blood vessel is definitely the future direction of surgical development.