直肠癌根治术中保留左结肠动脉对吻合口瘘及手术时间的影响

Effect of preserving left colic artery during radical operation of rectal cancer on anastomotic leakage and operation time

全直肠系膜切除（TME）原则和腹腔镜技术的普及应用为直肠癌手术带来了巨大的变革。腹腔镜直肠TME手术所涉及的血管处理主要针对肠系膜下动脉及其分支。结扎肠系膜下动脉的方式有两种：不保留左结肠动脉的高位结扎和保留左结肠动脉的低位结扎。本文回顾并分析近年来最新的国内外文献，并结合临床实践经验，对直肠癌根治术中保留左结肠动脉对吻合口瘘和手术时间这两个方面的影响作一评述，以期为肠系膜下动脉处理方式的选择提供参考。

Surgical treatment for rectal cancer has changed radically in recent years since the introduction of the principle of total mesorectal excision （TME） and technique of laparoscopic approach. The emphasis of management for vessels in laparoscopic TME surgery for rectal cancer is mainly focused on the inferior mesenteric artery （IMA） and its branches. Two alternatives of the level to execute the IMA are high ligation （without preservation of left colic artery, LCA） and low ligation （with preservation of LCA）. In this article, we review the latest literature from China and foreign countries concerning this issue, and combine with our own experience toinvestigate the effect of LCA preserving on anastomotic leakage and operation time, which may provide a reference for proper choice of the management of IMA in rectal cancer surgery.