左结肠动脉保护的急性直肠癌手术:一篇文献评论
Xiyin Yang1, Yuanshui Sun2, Qiang Hu3,4
1Department of Traditional Chinese Medicine, Community Health Service Center of Guali Town of Xiaoshan, Hangzhou, China.
Frontiers in surgery
|January 21, 2026
概括
在直肠癌手术中保存左结肠动脉 (LCA) 与高结节绑定的瘤结果相匹配. 维护LCA提高了安全性和功能,使其成为首选的手术方法.
科学领域:
- 手术瘤学手术瘤学
- 胃肠道手术 胃肠道手术
- 血管解剖学 血管解剖学
背景情况:
- 彻底的直肠癌手术涉及复杂的血管考虑.
- 控制下腹中腔动脉 (IMA) 和它的分支,特别是左腹动脉 (LCA),对于手术成功至关重要.
- 在瘤控制与功能性保存之间取得平衡是关键的挑战.
研究的目的:
- 审查当前关于在急性直肠癌手术期间保护左结肠动脉 (LCA) 的证据.
- 评估LCA保存的解剖学理由,外科手术技术,瘤安全性和功能结果.
- 为了比较LCA保护程序与传统的高结合IMA结合.
主要方法:
- 在PubMed,Embase,Cochrane图书馆和CNKI对过去二十年的研究进行了全面的文献搜索.
- 包括随机试验,队列研究和元分析,比较高结合率的IMA结合与低结合率的LCA保存程序.
- 关键的终点包括整体存活率,无病存活率,局部复发,静脉漏,功能结果和术后恢复.
主要成果:
- 在5年整体存活率,无病存活率,局部复发率或R0切除率上,在结策略之间没有显著差异.
- 在临床上,LCA的保存显著减少了静脉流动性泄漏.
- 经手术后尿路,性和肠道功能得到改善,住院时间更短,胃肠道恢复更快,随着LCA的保存而观察到.
- 先进的成像技术 (CTA,MRA) 和手术内技术 (绿色光) 有助于规划和执行.
结论:
- 左大肠动脉 (LCA) 的保存提供了瘤学结果,当维护D3淋巴结解剖时,相当于高粘结结合.
- 维护LCA在外科手术期间的安全性和长期功能结果方面提供了显著的优势.
- 低结合性LCA保护切除被推为大多数低前置切除的首选方法,除非有特定的禁忌.
- 未来的研究,包括多中心试验和人工智能辅助研究,是必要的,以改进指示和确定高风险子组.
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