在不转移口腔管的情况下进行腹腔镜间切除的患者选择和手术策略
Gang Hu1, Ji Ma2, Wen-Long Qiu1
1Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
World journal of gastrointestinal surgery
|March 31, 2025
概括
由于直肠癌而进行间切除的女性患者可以通过保存左结肠动脉 (LCA) 来避免转移静脉 (DS). 这种方法,特别是在没有新辅助化学放射治疗 (nCRT) 的情况下,可以减少静脉瘤并发症,而不会影响存活率.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 转向性静脉口腔 (DS) 在超低直肠癌的间切除中很常见.
- 静脉障碍与口腔阻塞并发症和医疗费用增加有关.
- 识别可以避免DS的患者对于改善结果至关重要.
研究的目的:
- 确定患者选择标准,以避免在间切除中转移静脉管 (DS).
- 评估影响无口腔泄漏 (AL) 的因素在无口腔 (SF) 患者.
主要方法:
- 追溯分析505名经历了间切除的患者.
- 78名无口腔 (SF) 患者和78名转移口腔 (DS) 患者的匹配比较.
- 分析了解静脉泄漏 (AL) 率,整体存活率和无病存活率.
主要成果:
- 与DS组 (2.6%) 相比,SF组 (12.8%) 的AL率显著更高.
- 对AL的独立风险因素包括男性性别,新辅助化学放射治疗 (nCRT) 和瘤高度≤4厘米.
- 在这两组中,左结肠动脉 (LCA) 的保存是对AL的保护因素. 没有nCRT和LCA保存的女性患者的AL率较低 (2.1%).
结论:
- 没有接受nCRT的女性患者可以通过保存LCA来避免DS.
- 这种策略可以在不影响瘤结果的情况下降低AL风险.
- 在选择患者进行无静脉切除时,LCA的保存是关键因素.
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