Clinical study of three-dimensional CT reconstruction technology guiding preserving the left colonic artery during laparoscopic radical resection of rectal cancer

OUYANG Jun-feng; FU Yan; SHEN Wen-qiang; HU Yu-fei

doi:10.11659/jjssx.01E024045

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Clinical study of three-dimensional CT reconstruction technology guiding preserving the left colonic artery during laparoscopic radical resection of rectal cancer

Clinical Research | 更新时间：2025-01-16

- Clinical study of three-dimensional CT reconstruction technology guiding preserving the left colonic artery during laparoscopic radical resection of rectal cancer
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 34, Issue 1, Pages: 58-61(2025)
- 作者机构：
  
  十堰市太和医院普外四病区，湖北十堰 442000
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.01E024045
  CLC： R735.3+7
- Published：25 January 2025，
  
  Received：09 January 2024，
- 稿件说明：
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OUYANG JUN-FENG, FU YAN, SHEN WEN-QIANG, et al. Clinical study of three-dimensional CT reconstruction technology guiding preserving the left colonic artery during laparoscopic radical resection of rectal cancer. [J]. Journal of regional anatomy and operative surgery, 2025, 34(1): 58-61.
DOI：

OUYANG JUN-FENG, FU YAN, SHEN WEN-QIANG, et al. Clinical study of three-dimensional CT reconstruction technology guiding preserving the left colonic artery during laparoscopic radical resection of rectal cancer. [J]. Journal of regional anatomy and operative surgery, 2025, 34(1): 58-61. DOI： 10.11659/jjssx.01E024045.

摘要

目的

探讨术前行全腹部三维CT重建指导腹腔镜下直肠癌根治术中保留左结肠动脉的意义及临床应用价值。

方法

选取2021年1月至2022年1月于我院行腹腔镜下直肠癌根治术的直肠癌患者为研究对象，术前均行全腹部三维CT重建，筛选出均有左结肠动脉的87例患者，随机分为观察组（术中低位结扎肠系膜下动脉，保留左结肠动脉）40例和对照组（术中高位结扎肠系膜下动脉，不保留左结肠动脉）47例。比较2组患者围术期指标及术后病理结果。

结果

观察组患者术中出血量高于对照组，手术时间长于对照组，差异均有统计学意义（

0.05）。观察组患者术后肠梗阻及吻合口漏发生率低于对照组，术后首次排气时间早于对照组，差异均有统计学意义（

0.05）。2组患者在肿瘤分化程度、肿瘤大小、腺癌分型、肠系膜下动脉根部淋巴结清扫数目、肿瘤侵犯肠壁深度分期方面差异均无统计学意义（

0.05）。

结论

术前行全腹部三维CT重建可预先了解肠系膜下动脉的分支分型情况，确定肿瘤位置及其与周围组织的毗邻关系，明确肠段切除范围；术中保留左结肠动脉能减少患者术后并发症的发生，具有积极的临床意义。

Abstract

Objective

To investigate the significance and clinical value of preoperative three-dimensional CT reconstruction of the whole abdomen guiding preserving the left colonic artery during laparoscopic radical resection of rectal cancer.

Methods

Patients with rectal cancer who underwent laparoscopic radical resection of rectal cancer in our hospital from January 2021 to January 2022 were selected， then 87 patients with left colonic artery were screened out through three-dimensional CT reconstruction of the whole abdomen before surgery， who were randomly divided into the observation group （received intraoperative low ligation of the inferior mesenteric artery， with preservation of the left colonic artery） with 40 cases and the control group （received intraoperative high ligation of the inferior mesenteric artery without preservation of the left colonic artery） with 47 cases. The perioperative indexes and postoperative pathological results of the two groups were compared.

Results

The intraoperative blood loss in the observation group was higher than that in the control group， and the operation time was longer than that in the control group， with statistically significant differences （

0.05）. The incidences of postoperative intestinal obstruction and anastomotic leakage in the observation group were lower than those in the control group， and the first postoperative discharge time was earlier than that in the control group， with statistically significant differences （

0.05）. There was no significant difference in the degree of tumor differentiation， tumor size， adenocarcinoma classification， number of lymph nodes dissected at the root of the inferior mesenteric artery， or the stage of intestinal wall invasion depth of tumor between the two groups （

0.05）.

Conclusion

The application of the three-dimensional CT reconstruction of the whole abdomen before surgery can understand the branch classification of the inferior mesenteric artery in advance， determine the location of the tumor and its adjacent relationship with the surrounding tissues， and determine the resection extent of intestinal segment. Intraoperative preservation of the left colonic artery can reduce the occurrence of postoperative complications in patients， which has positive clinical significance.

关键词

直肠恶性肿瘤左结肠动脉高位结扎低位结扎吻合口漏三维CT重建

Keywords

rectal cancerleft colonic arteryhigh ligationlow ligationanastomotic leakagethree-dimensional CT reconstruction

references

Morgan E，Arnold M，Gini A， et al. Global burden of colorectal cancer in 2020 and 2040： incidence and mortality estimates from GLOBOCAN［J］.Gut，2023，72（2）：338-344. doi： 10.1136/gutjnl-2022-327736http://dx.doi.org/10.1136/gutjnl-2022-327736.

Heald RJ， Husband EM， Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence？［J］. Br J Surg， 1982， 69（10）： 613-616.doi： 10.1002/bjs.1800691019http://dx.doi.org/10.1002/bjs.1800691019.

汪冠聪，郭银枞，凌碧娟，等.保留左结肠动脉对腹腔镜中低位直肠癌根治术后吻合口漏的影响［J］.腹腔镜外科杂志，2021，26（9）：671-674.doi：10.13499/j.cnki.fqjwkzz.2021.09.671http://dx.doi.org/10.13499/j.cnki.fqjwkzz.2021.09.671.

Lange MM， Buunen M， van de Velde CJ，et al. Level of arterial ligation in rectal cancer surgery： low tie preferred over high tie. A review［J］. Dis Colon Rectum， 2008，51（7）：1139-145. doi： 10.1007/s10350-008-9328-yhttp://dx.doi.org/10.1007/s10350-008-9328-y.

Yada H， Sawai K， Taniguchi H， et al. Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer［J］. World J Surg， 1997， 21（1）： 109-115. doi： 10.1007/s002689900202http://dx.doi.org/10.1007/s002689900202.

中华医学会外科学分会腹腔镜与内镜外科学组，中华医学会外科学分会结直肠外科学组，中国医师协会外科医师分会结直肠外科专家工作组，等. 腹腔镜结直肠癌根治术操作指南（2023版）［J］. 中华消化外科杂志， 2024， 23（1）： 10-22.doi：10.3760/cma.j.cn115610-20231229-00285http://dx.doi.org/10.3760/cma.j.cn115610-20231229-00285.

郑恢超，张勇，田跃，等. 直肠癌根治术前三维CT血管成像评估肠系膜下动脉分型可行性研究［J］. 中国实用外科杂志， 2019，39（7）：704-707.doi： 10.19538/j.cjps.issn1005-2208.2019.07.15http://dx.doi.org/10.19538/j.cjps.issn1005-2208.2019.07.15.

吴传福，钱正海，郎建华，等.肠系膜下动脉在腹腔镜直肠癌根治术中的处理方式及保留左结肠动脉的临床意义［J］.腹腔镜外科杂志，2019，24（4）：267-270.doi：10.13499/j.cnki.fqjwkzz.2019.04.267http://dx.doi.org/10.13499/j.cnki.fqjwkzz.2019.04.267.

孙康，党胜春，瞿建国，等.保留左结肠动脉的腹腔镜直肠癌根治术在加速康复外科中的临床价值［J］.实用医学杂志，2020，36（7）：869-873.doi：10.3969/j.issn.1006-5725.2020.07.008http://dx.doi.org/10.3969/j.issn.1006-5725.2020.07.008.

骆洋，俞旻皓，敬然，等.腹腔镜低位直肠癌前切除术后吻合口漏危险因素分析及其风险评估量表应用价值的多中心回顾性研究［J］.中华消化外科杂志，2021，20（12）：1342-1350. doi：10.3760/cma.j.cn115610-20211020-00514http://dx.doi.org/10.3760/cma.j.cn115610-20211020-00514.

De Simone B，Coccolini F，Ansaloni L，et al.Complicated colorectal cancer in nonagenarian patients： is it better not to perform anastomosis in emergency？［J］.Ulus Travma Acil Cerrahi Derg， 2017，23（1）：15-22.doi： 10.5505/tjtes.2016.77178http://dx.doi.org/10.5505/tjtes.2016.77178.

邓书田，伍红，刘牧林，等.左结肠动脉保留在腹腔镜下直肠癌根治术中的临床价值［J］.局解手术学杂志，2024，33（4）：346-348. doi： 10.11659/jjssx.04E023056http://dx.doi.org/10.11659/jjssx.04E023056.

Mari GM， Crippa J， Cocozza E， et al. Low ligation of inferior mesenteric artery in laparoscopic anterior resection for rectal cancer reduces genitourinary dysfunction： results from a randomized controlled trial （HIGHLOW Trial）［J］. Ann Surg，2019， 269（6）：1018-1024.doi： 10.1097/SLA.0000000000002947http://dx.doi.org/10.1097/SLA.0000000000002947.

Chew MH， Yeh YT， Lim E， et al. Pelvic autonomic nerve preservation in radical rectal cancer surgery： changes in the past 3 decades［J］.Gastroenterol Rep （Oxf）， 2016，4（3）：173-185. doi： 10.1093/gastro/gow023http://dx.doi.org/10.1093/gastro/gow023.

Uehara K， Yamamoto S， Fujita S， et al.Impact of upward lymph node dissection on survival rates in advanced lower rectal carcinoma［J］.Dig Surg，2007，24（5）：375-381.doi： 0.1159/000107779http://dx.doi.org/0.1159/000107779.

Boström P， Haapamäki MM， Matthiessen P，et al. Higharterial ligation and risk of anastomotic leakage in anterior resection for rectal cancer in patients with increased cardiovascular risk［J］. Colorectal Dis，2015，17（11）：1018-1027. doi： 10.1111/codi.12971http://dx.doi.org/10.1111/codi.12971.

周东旭，邓洋，李兆朋，等.直肠癌根治术保留左结肠动脉的疗效评价与Meta分析［J］.安徽医药，2020，24（8）：1485-1493.doi：10.3969/j.issn.1009-6469.2020.08.001http://dx.doi.org/10.3969/j.issn.1009-6469.2020.08.001.

Chin CC， Yeh CY， Tan R， et al. The oncologic benefit of high ligation of the inferior mesenteric artery in the surgical treatment of rectal or sigmoid colon cancer［J］.Int J Colorectal Dis，2008，23（8）：783-788. doi： 10.1007/s00384-008-0465-5http://dx.doi.org/10.1007/s00384-008-0465-5.

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