游离结肠脾曲在中高位直肠癌与乙状结肠癌全系膜切除术中的现状与展望

Actuality and prospect of mobilization of the splenic flexure in total mesorectal excision for middle and high rectal cancer and sigmoid colon cancer

中高位直肠癌与乙状结肠癌全系膜切除术中是否选择性或常规游离结肠脾曲仍存在争议。目前缺少对中高位直肠癌与乙状结肠癌具体游离范围及淋巴结清扫范围的前瞻性随机对照研究,由于结肠脾曲有复杂的系膜、筋膜结构,比邻胰腺与脾脏,游离结肠脾曲将存在增加术中风险、延长手术时间的可能。因此,一部分学者认为游离结肠脾曲是中高位直肠癌与乙状结肠癌全直肠系膜切除术的关键步骤,其将为结直肠吻合提供宽松的结肠冗余以减小吻合口张力,但是常规游离结肠脾曲并未取得预定的受益,吻合口张力、术后吻合口漏、术后复发不是远期生存方面的保护因素。中高位直肠癌与乙状结肠癌全直肠系膜切除术中游离结肠脾曲的绝对适应证依然有待探索,本文将对中高位直肠癌与乙状结肠癌全直肠系膜切除术中选择性或常规游离结肠脾曲的现状及进展进行综述。

Mobilization of the splenic flexure is a controversial choice in total mesorectal excision(TME)for middle-high rectal cancer and sigmoid colon cancer.At present,there is no prospective randomized controlled study on the specific free range and lymph node dissection range of mid-high rectal cancer and sigmoid colon cancer,because the splenic flexure of colon has complex structure of mesentery and fascia,adjacent to pancreas and spleen,it may increase the risk of operation and prolong the time of operation,therefore,some scholars believe that mobilization of the splenic flexure is a key step in TME for middle and high rectal cancer and sigmoid colon cancer,which will provide loose colonic redundancy for colorectal anastomosis to reduce anastomotic tension.However,routine mobilization of the splenic flexure did not achieve the expected benefits,and was not a protective factor in anastomotic tension,postoperative anastomotic leakage,postoperative recurrence and long-term survival.The absolute indication of mobilization of the splenic flexure in total mesorectal excision for middle and high rectal cancer and sigmoid colon cancer remains to be explored,this article will review the current status and progress of selective or conventional mobilization of the splenic flexure in TME for middle and high rectal cancer and sigmoid colon cancer.excision。