Effect of preserving left colic artery on the hemodynamics of the rectal anastomosis

LAN Ke; YANG Hua; SHU Shi-long; PENG Xue-feng; ZHANG Fa-qiang

doi:10.11659/jjssx.09E025002

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Effect of preserving left colic artery on the hemodynamics of the rectal anastomosis

Clinical Research | 更新时间：2026-05-25

- Effect of preserving left colic artery on the hemodynamics of the rectal anastomosis
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 35, Issue 5, Pages: 432-436(2026)
- 作者机构：
  
  自贡市第四人民医院普外科，四川自贡 643000
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.09E025002
  CLC： R615
- Received：01 September 2025，
  
  Published：25 May 2026
- 稿件说明：
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兰柯,杨华,舒仕龙等.保留左结肠动脉对直肠吻合口血流动力学的影响[J].局解手术学杂志,2026,35(05):432-436.

LAN Ke,YANG Hua,SHU Shi-long,et al.Effect of preserving left colic artery on the hemodynamics of the rectal anastomosis[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(05):432-436.
兰柯,杨华,舒仕龙等.保留左结肠动脉对直肠吻合口血流动力学的影响[J].局解手术学杂志,2026,35(05):432-436. DOI： 10.11659/jjssx.09E025002.

LAN Ke,YANG Hua,SHU Shi-long,et al.Effect of preserving left colic artery on the hemodynamics of the rectal anastomosis[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(05):432-436. DOI： 10.11659/jjssx.09E025002.

摘要

目的

利用术中超声测量吻合口附近结肠边缘动脉（MAD）的血流速度，辅助判断吻合口的血供，从而探索保留左结肠动脉（LCA）对吻合口近端血供的影响。

方法

纳入2021年1月至2023年1月于我院接受腹腔镜直肠癌前切除术的患者40例。统计肠系膜下动脉（IMA）分支的类型。测量IMA根部到第1分支的长度，以及IMA、LCA、MAD的直径。术中超声测量IMA夹闭前后吻合口附近MAD的血流速度，并记录超声波形。利用Tardus-Parvus波形评估吻合口的低灌注状态。采用单因素

Logistic

回归分析评估各临床及影像学变量与Tardus-Parvus波形发生的相关性，并观察患者围术期情况。

结果

IMA最常见的分支类型为Ⅰ型（82.5%），其余依次为Ⅱ型（2.5%）、Ⅲ型（15.0%）、Ⅳ型（0）。IMA长度为（3.3±0.8）cm，LCA、MAD、IMA的直径分别为（3.0±1.1） mm、（2.2±0.5）mm、（5.0±0.8）mm。IMA夹闭前MAD平均血流速度高于夹闭后（

0.05）。13例（32.5%）患者在IMA夹闭后出现Tardus-Parvus波形。单因素

Logistic

回归分析显示，Tardus-Parvus波形的出现与高龄、LCA直径及LCA直径/MAD直径显著相关（

0.05）。术中成功完成了253淋巴结的清扫，仅在2例（5.0%）患者清扫的淋巴结中发现癌细胞。患者均保留LCA，未出现吻合口漏。有4例（10.0%）患者吻合口处存在一定张力，6例（15.0%）患者在拔除导尿管后出现尿潴留，出院前均已恢复。

结论

保留LCA可改善直肠癌手术中吻合口附近的灌注。术中超声可以评估吻合口附近的灌注情况，高龄和LCA直径可作为IMA结扎后肠系膜低灌注状态的预测指标。

Abstract

Objective

To use intraoperative ultrasound for measuring the blood flow velocity of the colonic marginal artery of Drummond （MAD） near the anastomosis to assist in assessing the blood supply to the anastomosis， thereby exploring the effect of preserving left colic artery （LCA） on the blood supply to the proximal anastomosis.

Methods

Forty patients who underwent laparoscopic anterior resec

tion for rectal cancer at our hospital from January 2021 to January 2023 were enrolled. The branching patterns of the inferior mesenteric artery （IMA） were collected. The length from the root of IMA to its first branch，as well as the diameters of the IMA，LCA，and MAD were measured. The blood flow velocity of the MAD near the anastomosis was detected by intraoperative ultrasound before and after IMA clamping， and the ultrasound waveforms were recorded. The hypoperfusion of anastomosis was determined by Tardus‑Parvus waveforms. Univariate

Logistic

regression was used to assess the association between clinical/imaging variables and the presence of Tardus‑Parvus waveforms， and perioperative status of patients were monitored.

Results

The most common branching pattern of the IMA was type Ⅰ （82.5%）， followed by type Ⅱ （2.5%）， type Ⅲ （15.0%）， and type Ⅳ （0）. The length of the IMA was （3.3±0.8）cm.The diameters were （3.0±1.1）mm for LCA，（2.2±0.5）mm for MAD， and （5.0±0.8）mm for IMA. The mean blood flow velocity of the MAD before IMA clamping was higher than that after clamping （

0.05）.Thirteen patients （32.5%） exhibited Tardus-Parvus waveforms after IMA clamping. Univariate

Logistic

regression analysis showed that the occurrence of the Tardus‑Parvus waveform was significantly correlated with advanced age， LCA diameter， and the LCA diameter/MAD diameter （

0.05）. During surgery， a total of 253 lymph nodes were successfully dissected， and cancer cells were found in the dissected lymph nodes of only 2 patients （5.0%）. The LCA was preserved in all patients， while no anastomotic leakage developed. There was certain tension at the anastomosis in 4 patients （10.0%）， and 6 patients （15.0%） developed urinary retention after catheter removal， all of whom recovered before discharge.

Conclusion

Preserving LCA improves perfusion near the anastomosis in rectal cancer surgery. Intraoperative ultrasound can assess the perfusion near the anastomosis， and advanced age along with LCA diameter may serve as predictors of mesenteric hypoperfusion after IMA ligation.

关键词

Keywords

references

Yu J ， Chen Y ， Li T ， et al . High and low inferior mesenteric artery ligation in laparoscopic low anterior rectal resections： a retrospective study ［J］. Front Surg ， 2023 ， 9 ： 1027034 . doi： 10.3389/fsurg.2022. 1027034 http://dx.doi.org/10.3389/fsurg.2022.1027034 .

Reyaz I ， Reyaz N ， Salah QM ， et al . Comparison of high ligation versus low ligation of the inferior mesenteric artery（IMA） on short-term and long-term outcomes in sigmoid colon and rectal cancer surgery： a meta-analysis ［J］. Cureus ， 2023 ， 15 （ 5 ）： e39406 . doi： 10.7759/cureus.39406 http://dx.doi.org/10.7759/cureus.39406 .

Yang X ， Ma P ， Zhang X ， et al . Preservation versus non-preservation of left colic artery in colorectal cancer surgery： an updated systematic review and meta-analysis ［J］. Medicine ， 2019 ， 98 （ 5 ）： e13720 . doi： 10.1097/MD.0000000000013720 http://dx.doi.org/10.1097/MD.0000000000013720 .

Zeng J ， Su G . High ligation of the inferior mesenteric artery during sigmoid colon and rectal cancer surgery increases the risk of anastomotic leakage： a meta-analysis ［J］. World J Surg Oncol ， 2018 ， 16 （ 1 ）： 157 . doi： 10.1186/s12957-018-1458-7 http://dx.doi.org/10.1186/s12957-018-1458-7 .

Bonnet S ， Berger A ， Hentati N ， et al . High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery： impact on the gain in colon length and implications on the feasibility of anastomoses ［J］. Dis Colon Rectum ， 2012 ， 55 （ 5 ）： 515 - 521 . doi： 10.1097/DCR.0b013e318246f1a2 http://dx.doi.org/10.1097/DCR.0b013e318246f1a2 .

Buunen M ， Lange MM ， Ditzel M ， et al . Level of arterial ligation in total mesorectal excision（TME）： an anatomical study ［J］. Int J Colorectal Dis ， 2009 ， 24 （ 11 ）： 1317 - 1320 . doi： 10.1007/s00384-009-0761-8 http://dx.doi.org/10.1007/s00384-009-0761-8 .

Kato H ， Munakata S ， Sakamoto K ， et al . Impact of left colonic artery preservation on anastomotic leakage in laparoscopic sigmoid resection and anterior resection for sigmoid and rectosigmoid colon cancer ［J］. J Gastrointest Cancer ， 2018 ， 48 （ 7 ）： 725 - 732 . doi： 10.1007/s12029-018-0126-z http://dx.doi.org/10.1007/s12029-018-0126-z .

Yang Y ， Wang G ， He J ， et al . High tie versus low tie of the inferior mesenteric artery in colorectal cancer： a meta-analysis ［J］. Int J Surg ， 2018 ， 52 ： 20 - 24 . doi： 10.1016/j.ijsu.2017.12.030 http://dx.doi.org/10.1016/j.ijsu.2017.12.030 .

Guo J ， Sim SKR ， Teo NZ ， et al . Pitfalls of indocyanine green perfusional assessment in colorectal anastomosis ［J］. ANZ J Surg ， 2022 ， 92 （ 7/8 ）： 1602 - 1605 . doi： 10.1111/ans.17910 http://dx.doi.org/10.1111/ans.17910 .

Son GM ， Kim TU ， Park BS ， et al . Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients ［J］. Ann Surg Treat Res ， 2019 ， 97 （ 2 ）： 74 - 82 . doi： 10.4174/astr.2019.97.2.74 http://dx.doi.org/10.4174/astr.2019.97.2.74 .

Kotval PS . Doppler waveform parvus and tardus.A sign of proximal flow obstruction ［J］. J Ultrasound Med ， 1989 ， 8 （ 8 ）： 435 - 440 . doi： 10.7863/jum.1989.8.8.435 http://dx.doi.org/10.7863/jum.1989.8.8.435 .

Gunabushanam G ， Millet JD ， Stilp E ， et al . Computer-assisted detection of tardus parvus waveforms on Doppler ultrasound ［J］. Ultrasound ， 2017 ， 26 （ 2 ）： 81 - 92 . doi： 10.1177/1742271X17747135 http://dx.doi.org/10.1177/1742271X17747135 .

Kriaa S ， Zbidi M ， Hafsa C ， et al . Tardus-parvus Doppler waveform in the renal arteries of an adult patient suggesting aortic coarctation ［J］. J Clin Ultrasound ， 2006 ， 34 （ 9 ）： 458 - 460 . doi： 10.1002/jcu.20267 http://dx.doi.org/10.1002/jcu.20267 .

Tiselius C ， Kindler C ， Rosenblad A ， et al . Localization of mesenteric lymph node metastases in relation to the level of arterial ligation in rectal cancer surgery ［J］. Eur J Surg Oncol ， 2019 ， 45 （ 6 ）： 989 - 994 . doi： 10.1016/j.ejso.2019.01.183 http://dx.doi.org/10.1016/j.ejso.2019.01.183 .

Hinoi T ， Okajima M ， Shimomura M ， et al . Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer ［J］. World J Surg ， 2013 ， 37 （ 12 ）： 2935 - 2943 . doi： 10.1007/s00268-013-2194-3 http://dx.doi.org/10.1007/s00268-013-2194-3 .

Krohg-Sorensen K ， Lunde OC . Perfusion of the human distal colon and rectum evaluated with endoscopic laser Doppler flowmetry.Methodologic aspects ［J］. Scand J Gastroenterol ， 1993 ， 28 （ 2 ）： 104 - 108 . doi： 10.3109/00365529309096054 http://dx.doi.org/10.3109/00365529309096054 .

朱秋伟，华卫俊，傅跃，等 . 腹腔镜乙状结肠癌根治术中保留左结肠动脉及直肠上动脉对老年患者的效果分析［J］. 实用临床医药杂志， 2023 ， 27 （ 5 ）： 82 - 84 . doi： 10.7619/jcmp.20222913 http://dx.doi.org/10.7619/jcmp.20222913 .

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