乙状结肠系膜粘连分型对腹腔镜低位直肠癌前切术中的意义

Clinical significances of sigmoid mesocolon variation on laparoscopic anterion section for low rectal cancer

目的探讨不同乙状结肠系膜粘连分型对腹腔镜低位直肠癌前切术手术方式的临床意义。方法回顾性分析114例低位直肠癌手术患者乙状结肠系膜粘连形态,统计Ⅰ型、Ⅱ型和Ⅲ型乙状结肠长度、系膜长度、系膜边缘血管弓距肠壁的距离、系膜根部距边缘血管弓的距离及系膜附着点距离,同时统计离断系膜根部血管后系膜边缘血管弓的血供及术后吻合口瘘的情况。结果乙状结肠肠管长度Ⅰ型为(47.8±4.5)cm,Ⅱ型为(34.6±2.1)cm,Ⅲ型为(30.4±3.7)cm;系膜长度Ⅰ型为(13.8±2.1)cm,Ⅱ型为(8.9±1.3)cm,Ⅲ型为(11.2±1.5)cm;系膜根部距边缘血管弓的距离Ⅰ型为(11.8±2.0)cm,Ⅱ型为(7.2±1.8)cm,Ⅲ型为(9.4±1.1)cm。Ⅰ型、Ⅱ型和Ⅲ型之间乙状结肠长度、系膜长度、系膜根部距边缘血管弓的距离之间存在明显差异性,离断肠系膜下动脉根部血管后,Ⅰ型边缘血管弓血供最好,Ⅱ、Ⅲ型血供较差,Ⅰ型未出现吻合口瘘,Ⅱ型、Ⅲ型各3例吻合口瘘发生。结论注意乙状结肠系膜粘连分型可提高腹腔镜下低位直肠癌前切术的安全性。

Objective To investigate the types of sigmoid mesocolon variation and its effects on laparoscopic anterior resection for low rectal cancer. Methods Sigmoid mesocolon variation of 114 early stage low rectal cancer patients with laparoscopic anterior resection were collected retrospectively at our hospital. The anatomic variations were divided into three types, statistic the lengths of sigmoid colon, sigmoid mesocolon, the distance between marginal vessels and siginoid colon wall, the distance between marginal vessels and mesenteric roots , the distance of the two attachment points of sig- moid colon, the blood supply of the marginal vessels in sigmoid mesentery after high ligation of inferior mesenteric artery （IMA） and postoperative anastomotic fistula incidence were also observed. Results The lengths of sigmoid colon ： type Ⅰ was （47. 8 ± 4. 5 ） cm, type Ⅱ was （34. 6 ± 2. 1 ） cm, and typeⅢ was （ 30. 4 ± 3.7） cm; The lengths of sigmoid mesoco- Ion： type I was （ 13.8 ± 2. 1 ） cm, type Ⅱ was （8. 9 ± 1.3 ） cm, and type Ⅲ was （ Ⅰ 1.2 ±1. 5 ） cm; The distance between marginal vessels and mesenteric roots ： type I was （ 11.8 ±2. 0） cm, type Ⅱ was （ 7.2 ± 1.8 ） cm, and type Ⅲ was （9. 4 ± 1.1 ） cm; There was significant difference between the types of the lengths of sigmoid colon, sigmoid mesocolon and the distance between marginal vessels and mesenteric roots;the blood supply of the marginal vessels is rich in type Ⅰ , which is better than type Ⅱ and type IU ;There was no anastomotic fistula in type Ⅰ ,while there were 3 cases in type Ⅱ and type m respectively. Conclusion The attention to sigmoid mesocolon variation can increase the safety of laparo- scopic anterior resection for low rectal cancer.