Arterias sigmoideas: bases para una nueva clasificación / Sigmoid arteries: bases for a new classification

Las arterias sigmoideas son ramas de la arteria mesentérica inferior e irrigan al colon sigmoideo. Se originan del tronco de las arterias sigmoideas. Esta es la descripción más frecuente según los autores consultados. El objetivo fue analizar las variaciones en el origen y distribución de las arterias sigmoideas mediante disección. Se utilizaron 13 preparados cadavéricos formolizados al 10 %. Se disecó la cavidad abdominal para identificar a las arterias sigmoideas. Se evidenció su bifurcación paralela al colon sigmoideo. Se lo delimitó mediante reparos palpables. Patrón I: 4 casos (30,8 %). Variante de la arcada sigmoidea como rama colateral de la arteria mesentérica inferior. Tipo Ia: 1 caso (25 %). Sin asociaciones. Tipo Ib: 1 caso (25 %). Asociada al tronco sigmoideo. Tipo Ic: 2 casos (50 %). Asociada a arterias sigmoideas accesorias. Patrón II: 6 casos (46,2 %). Variante del tronco común entre arteria cólica izquierda y arterias destinadas al colon sigmoideo. Tipo IIa: 3 casos (50 %). Sin asociaciones. Tipo IIb: 2 casos (33,3 %). Asociado al tronco sigmoideo. Tipo IIc: 1 caso (16,7 %). Asociado a arterias sigmoideas accesorias. Patrón III: 3 casos (23 %). Variante clásica. Se definió por la ausencia del tronco común con la arteria cólica izquierda y de la arcada sigmoidea. Tipo IIIa: 2 casos (66,7 %). Un número variable de arterias sigmoideas nacen como ramas colaterales de la arteria mesentérica inferior, sin asociarse al tronco sigmoideo. Tipo IIIb: 1 caso (33,3 %). La arteria cólica izquierda emite como rama colateral la primera arteria sigmoidea y se asocia al tronco sigmoideo. 1. El patrón II es el prevalente en este trabajo (46,2 %). 2. La variante clásica no es la predominante en esta investigación (23 %). 3. La arcada sigmoidea tiene 53,8 % de incidencia.

SUMMARY: The sigmoid arteries are branches of the inferior mesenteric artery and supply the sigmoid colon. They originate from the trunk of the sigmoids. This is the most frequent description according to the consulted authors. The objective is to analyze the variations in the origin and distribution of the sigmoid arteries through dissection. 13 cadaveric preparations formalized at 10 % and instruments were used. The abdominal cavity was dissected to identify the sigmoid arteries. Its bifurcation parallel to the sigmoid colon is evident. It is delimited by palpable repairs. Pattern I: 4 cases (30.8 %). Variant of the sigmoid arcade as a collateral branch of the inferior mesenteric artery. Type Ia: 1 case (25 %). No associations. Type Ib: 1 case (25 %). Associated with the sigmoid trunk. Type Ic: 2 cases (50 %). Associated with accessory sigmoid arteries. Pattern II: 6 cases (46.2 %). Variant of the common trunk between the left colic artery and arteries destined for the sigmoid colon. Type IIa: 3 cases (50 %). No associations. Type IIb: 2 cases (33.3 %). Associated with the sigmoid trunk. Type IIc: 1 case (16.7 %). Associated with accessory sigmoid arteries. Pattern III: 3 cases (23 %). Classic variant. It was defined by the absence of the common trunk with the left colic artery and the sigmoid arcade. Type IIIa: 2 cases (66.7 %). A variable number of sigmoid arteries arise as collateral branches of the inferior mesenteric artery, without being associated with the sigmoid trunk. Type IIIb: 1 case (33.3 %). The left colic artery gives off the first sigmoid artery as a collateral branch and is associated with the sigmoid trunk. 1. Pattern II is the most prevalent in this study (46.2 %). 2. The classic variant is not the predominant one in this research (23 %). 3. The sigmoid arcade has a 53.8 % incidence.

A Case of Two-Stage Treatment of a Left Colic Artery Aneurysm and Marginal Artery Aneurysm with Severe Stenosis of the Celiac and Superior Mesenteric Arteries / 日本心臓血管外科学会雑誌

The patient is a 55-year-old woman. Enhanced contrast computed tomography (CT) was conducted to comprehensively assess the renal deformity, revealing a severe stenosis in proximity to the celiac artery (CA) and the point of origin of the superior mesenteric artery (SMA), as well as dilatation of the inferior mesenteric artery (IMA), an aneurysm of the left colic artery (LCAA), and a limbal aneurysm of the splenic flexure arcades. To address the LCAA, coil embolization was performed, and a two-stage bypass of the SMA was carried out to enhance blood flow to the visceral arteries, leading to IMA dilation amelioration.

Clinical efficacy of three-dimensional laparoscopic radical resection of rectal cancer with left colic artery preservation and natural orfice specimen extraction surgery / 中华消化外科杂志

Objective:To investigate the clinical efficacy of three-dimensional (3D) laparos-copic radical resection of rectal cancer with left colic artery preservation and natural orfice specimen extraction surgery (NOSES).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 186 patients with rectal cancer who were admitted to Henan Provincial People's Hospital from December 2018 to December 2019 were colleted. There were 120 males and 66 females, aged from 30 to 81 years, with a median age of 59 years. Patients underwent 3D laparoscopic radical resection of rectal cancer. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect survival of patients and tumor recurrence up to January 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and percentages. Result:(1) Surgical situations: 186 patients with rectal cancer under-went 3D laparoscopic radical resection and postoperative with left colic artery preservation and NOSES. The operation time was (123±24)minutes, volume of intraoperative blood loss was (30±20)mL, the numer of lymph nodes dissected was 15±7. The time to postoperative first flatus, time to semiliquid food intake, time to postoperative out-of-bed activities were (2.3±0.7)days, (4.1±1.4)days, (2.9±1.0)days, respectively. The incidence of postoperative complications was 8.06%(15/186). The duration of postoperative hospital stay of 186 patients was (6.6±1.9)days and the treatment cost was (3.8±1.1) ten thousand yuan. Results of postoperative pathological examination showed 54 cases of low differentiated adenocarcinoma, 97 cases of moderate differentiated adenocarcinoma, 19 cases of high differentiated adenocarcinoma and 16 cases of mucinous adenocarcinoma. (2) Follow-up: 186 patients with rectal cancer were followed up for 13 to 24 months, with a median follow-up time of 13 months. During the follow-up, 18 patients had tumor recurrence or metastasis including 6 patients of death, 168 cases recovered well.Conclusion:3D laparoscopic radical resection of rectal cancer with left colic artery preservation and NOSES is safe and feasible.

Controversy and progress on whether to retain left colonic artery in radical resection of rectal cancer / 中华胃肠外科杂志

Japanese Society for Cancer of the Colon and Rectum (JSCCR) guideline 2019 recommended that lymph node dissection for advanced rectal cancer should include the lymphatic adipose tissue at the root of the inferior mesenteric vessels, but the ligation site of the inferior mesenteric artery (IMA) was not determined, and the NCCN guideline did not indicate clearly whether to retain the left colonic artery (LCA). Controversy over whether to retain LCA is no more than whether it can reduce the incidence of anastomotic complications or postoperative functional damage without affecting the patients' oncological outcome. Focusing on the above problems, this paper reviews the latest research progress. In conclusion, it is believed that the advantages of retaining LCA are supported by most studies, which can improve the blood supply of the proximal anastomosis, and technically can achieve the same range of lymph node dissection as IMA high ligation. However, whether it affects the survival of patients, reduces the incidence of anastomotic leakage, and improves the quality of life of patients, more high-quality evidence-based medical evidence is still needed.

Effect of preservation of left colic artery on postoperative anastomotic leakage of patients with rectal cancer after neoadjuvant therapy / 中华胃肠外科杂志

Objective@#To evaluate the effect of preservation of left colic artery (LCA) on postoperative anastomotic leakage in patients with rectal cancer after neoadjuvant therapy.@*Methods@#A retrospective cohort study was conducted to collect data of rectal cancer patients at Department of Gastrointestinal Surgery of Fujian Cancer Hospital from September 2014 to August 2017. Inclusion criteria: (1) age of 18 to 79 years; (2) rectal adenocarcinoma confirmed by postoperative pathology; (3) patients without preoperative serious cardiovascular and cerebrovascular disease receiving preoperative neoadjuvant radiotherapy or chemoradiotherapy; (4) laparoscopic-assisted anterior rectal resection and distal ileostomy were performed simultaneously; (5) complete clinical data. Exclusion criteria: patients with extensive abdominal metastasis, or distant organ metastasis during operation, and combined organ resection. According to whether LCA was retained during operation, the patients were divided into two groups, then the intraoperative and postoperative clinical outcomes were compared. Moreover, univariate analysis and multivariate logistic regression were used to analyze risk factors of postoperative anastomotic leakage.@*Results@#A total of 125 patients were included in this study, including 56 patients in the retained LCA group and 69 patients in the non-retained LCA group. Differences in baseline data, such as gender, age, diabetes mellitus, body mass index, hemoglobin, distance between tumor and anal margin, maximum diameter of tumor, preoperative neoadjuvant therapy, and ypTNM stage, between retained LCA group and non-retained LCA group were not statistically significant (all P>0.05), indicating that two groups were comparable. Meanwhile there were no significant differences in operation time, intraoperative blood loss, total number of lymph node harvested, number of harvested lymph node at the root of inferior mesenteric artery, circumferential margin, anastomotic bleeding, or postoperative hospital stay between two groups (all P>0.05). Thirteen patients in the non-retained LCA group (18.8%) developed postoperative anastomotic leakage, including 7 cases of grade A, 5 cases of grade B and 1 case of grade C, while in the retained LCA group, only 5.4% (3/56) of patients developed postoperative anastomotic leakage, including 1 case of grade A and 2 cases of grade B without case of grade C, whose difference was statistically significant (U=1674.500, P=0.028). Univariate analysis showed that preoperative hemoglobin <120 g/L and non-retained LCA were associated with postoperative anastomotic leakage (both P<0.05). Multivariate analysis cofirmed that preoperative hemoglobin < 120 g/L (OR=3.508, 95% CI: 1.158 to 10.628, P=0.017) and non-retained LCA (OR=4.065, 95%CI: 1.074 to 15.388, P=0.031) were independent risk factors for postoperative anastomotic leakage. Median follow-up time was 31 months (16 to 51 months), and no long-term complication was found. Local recurrence and distant metastasis were found in 1 case (1.8%) and 7 case (12.5%) in the retained LCA group, while those were found in 2 cases (2.9%) and 5 cases (7.2%) respectively, in the non-retained LCA group, whose differences were not statistically significant (P=1.000, P=0.321 respectively).@*Conclusion@#Preservation of left colic artery not only can ensure radical lymph node dissection efficacy under the condition of similar operation time and blood loss, but also can effectively reduce the incidence of postoperative anastomotic leakage for rectal cancer patients after neoadjuvant therapy.

Clinical effects of laparoscopic left colic artery-preserving total mesorectal excison for middle-low rectal cancer / 中华消化外科杂志

Objective To investigate the clinical effects of laparoscopic left colic artery (LCA) preserving total mesorectal excision (TME) for middle-low rectal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 339 patients with middle-low rectal cancer who underwent laparoscopic TME in the First Affiliated Hospital of Nanjing Medical University from July 2016 to July 2017 were collected.There were 216 males and 123 females,aged from 35 to 89 years,with an average age of 62 years.No lymph node enlargement was detected at the root of inferior mesenteric artery as evaluated by preoperative examination.Of the 339 patients,173 undergoing laparoscopic TME with preservation of LCA and 166 without preservation of LCA were allocated into observation group and control group,respectively.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect complications and survival of patients after hospital discharge up to August 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the Mann-Whitney U test.Count data were represented as absolute number or percentage,and comparison between groups was analyzed using the chi-square test or Fisher exact propability.Comparisons of ordinal data were analyzed by Mann-Whitney U test.Results (1) Surgical situations:339 patients underwent laparoscopic TME successfully,without conversion to open surgery or death.The operation time,volume of intraoperative blood loss and number of lymph nodes dissected at the root of inferior mesenteric artery were (77± 15)minutes,(32±22)mL and 3.5± 1.3 in the observation group,(74± 16)minutes,(30±21) mL and 3.6± 1.3 in the control group,respectively,showing no statistically significant difference between the two groups (t =1.730,0.790,-0.378,P＞0.05).There were 21 and 37 patients receiving preventive stoma in the observation group and control group,with a statistically significant difference between the two groups (x2 =6.154,P＜0.05).(2) Postoperative situations:no lymphatic metastasis at the root of inferior mesenteric artery was detected in the observation group or control group.The incidence of anastomotic leakage was 8.55％ (13/152) and 16.28％(21/129) of patients without preventive stoma in the observation group and control group,with a statistically significant difference between the two groups (x2=3.917,P＜0.05).The overall incidence of anastomotic leakage was 7.51％ (13/173) and 12.65％ (21/166),with no statistically significant difference between the two groups (x2 =2.477,P＞0.05).Cases with anastomotic hemorrhage and time to first anal sufflation were 18 and (2.2±0.9) days in the observation group,10 and (2.4±1.0) days in the control group,respectively,showing no statistically significant difference between the two groups (x2 =2.145,t =-1.370,P＞0.05).(3) Follow-up:339 patients were followed up for 13-22 months,with a median time of 14 months.During the follow-up,2 patients had postoperative intestinal obstruction,19 had tumor recurrence or metastasis,and 4 died in the observation group.In the control group,1 patient had postoperative intestinal obstruction,17 had tumor recurrence or metastasis,and 3 died.The other patients in the two groups survived well.Conclusion Laparoscopic TME with preservation of LCA can reduce incidence of anastomotic leakage in patients with middle-low rectal cancer who don't undergo preventive stoma.

High ligation versus low ligation of the inferior mesenteric artery and lymph node dissection in laparoscopic rectal cancer surgery / 中华普通外科杂志

Objective To evaluate the surgical complications and root vascular lymph node dissection by high versus low ligation the inferior mesenteric artery (IMA) retaining left colonic artery (LCA) in laparoscopic radical resection of rectal cancer.Methods Clinical data of 357 cases of rectal cancer in our center from Jan 2015 to Dec 2016,were retrospectively analyzed,including 247 cases in high ligation group,110 cases of low ligation group.Results There was no statistically significant difference in operative time and intraoperative blood loss between the two groups [(105 ± 10)min vs.(113 ±9)min,t =0.138,P =0.092;(96 ± 21) ml vs.(99 ± 23) ml,t =0.171,P =0.118].Nor that in the incidence of anastomotic leakage between the two groups (7.3％ vs.4.5％,x2 =0.949,P =0.330).The incidence of low anterior resection syndrome in the two groups was statistically significant (21％ vs.12％,x2 =4.358,P =0.037).There was no significant difference in the total number of lymph nodes dissected between the two groups ([(14.5±4.3) vs.(13.6±3.5),t=1.851,P=0.065].Conclusion Low ligation of IMA with preservation of LCA in laparoscopic radical operation for rectal cancer provides better blood supply for proximal colon,while achieving same radical clearance of lymph nodes as with high ligation of IMA.

Effects and risk factors of low ligation of the inferior mesenteric artery on the third station lymph node dissection and metastasis in laparoscopic radical resection of rectal cancer / 中华消化外科杂志

Objective To explore the effects of low ligation of the inferior mesenteric artery (IMA) on the third station lymph node dissection in laparoscopic radical resection of rectal cancer (RC),and analyze the risk factors affecting the third station lymph node metastasis.Methods The retrospective cohort study was conducted.The clinical data of 380 RC patients who were admitted to Renji Hospital of Shanghai Jiaotong University School of Medicine from June 2014 to June 2016 were collected.Of 380 patients,177 with preservation of left colic artery (LCA) and 203 without preservation of LCA were respectively allocated into the low ligation group and high ligation group.All the patients received laparoscopic radical resection of RC based on the principle of total mesorectal excision (TME).Observation indicators:(1) intra-and post-operative recovery situations;(2) results of postoperative pathological examination;(3) follow-up and survival;(4) risk factors analysis affecting the third station lymph node metastasis.Follow-up using outpatient examination and telephone interview was performed to detect postoperative disease-free survival and tumor recurrence or metastasis up to May 31,2017.Measurement data with normal distribution were represented as x ± s,and comparisons between groups were evaluated with the t test.Comparisons of count data and ordinal data were respectively analyzed using the chisquare test and U test.The survival curve and survival rate were respectively drawn and analyzed using the KaplanMeier method,and the survival analysis was done by the Log-rank test.Results (1) Intra-and post-operative recovery situations:all the patients underwent successful surgery.The operation time,time to initial exsufflation and cases with anastomotic leakage were respectively (147.2±3.0) minutes,(72.8± 1.4)hours,20 in the low ligation group and (137.2±2.8) minutes,(76.6± 1.1) hours,38 in the high ligation group,with statistically significant differences between groups (t =2.463,2.073,x2 =4.025,P＜0.05).Volume of intraoperative blood loss,cases with temporary stoma,vascular injury (injury of inferior mesenteric vessels and presacral vein injury),urinary retention and duration of postoperative hospital stay were respectively (119±6)mL,25,29,24,(10.7± 0.5)days in the low ligation group and (108±5)mL,32,27,30,(9.6±0.4)days in the high ligation group,with no statistically significant difference between groups (t=1.524,x2 =0.235,0.716,1.115,t=1.780,P＞ 0.05).Of 58 patients with anastomotic leakage,31 received previously terminal loop ileostomy,13 received conservative treatment and 14 received postoperatively terminal loop ileostomy.Fifty-four patients with urinary retention received urethral catheterization.All the patients with complications were improved by treatment and then were discharged.(2) Results of postoperative pathological examination:number of lymph node dissected in the low ligation group and high ligation group was respectively 12.8±0.4 and 12.0±0.3;cases with depths of tumor invading to intestinal wall in stage pT1-T2 and pT3-T4,with tubular adenocarcinoma and non-tubular adenocarcinoma,with high-differentiated,moderate-differentiated and low-differentiated tumors,with lymph node metastasis in stage N0,N 1 and N2,with and without the third station lymph node metastasis,with TNM staging in stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ were respectively 53,124,150,27,81,63,33,73,66,38,16,161,17,54,93,13 in the low ligation group and 59,144,176,27,99,59,45,79,78,46,24,179,32,47,105,19 in the high ligation group,with no statistically significant difference in above indicators between groups (t =1.556,x2 =0.035,0.296,U=2.002,0.220,x2 =0.778,U=5.557,P＞0.05).(3) Follow-up and survival:338 of 380 patients were followed up for 6-36 months,with an average time of 28 months,including 164 in the low ligation group and 174 in the high ligation group.The 1-and 3-year disease-free survival rates and cases with postoperative tumor recurrence or metastasis were respectively 93.9％,76.4％,39 in the low ligation group and 94.8％,79.3％,36 in the high ligation group,with no statistically significant difference between groups (x2=0.861,P＞0.05).(4) Risk factors analysis affecting the third station lymph node metastasis:results of univariate analysis showed that tumor location and diameter,depth of tumor invading to intestinal wall and tumor histopathological type were related factors affecting the third station lymph node metastasis of RC patients (x2 =9.957,9.921,6.196,6.576,P＜0.05).Results of multivariate analysis showed that tumor diameter ＞ 5 cm and non-tubular adenocarcinoma were independent risk factors affecting the third station lymph node metastasis of RC patients (Odds ratio=2.561,2.296,95％ confidence interval:1.280-5.123,1.037-5.083,P＜0.05).Conclusions The low ligation of the IMA is safe and feasible in laparoscopic radical resection of RC,meanwhile,it has the same radical effect in lymph node dissection and doesn't affect the third station lymph node metastasis and shortterm disease-free survival compared with high ligation of the IMA.Tumor diameter ＞ 5 cm and non-tubular adenocarcinoma are independent risk factors affecting the third station lymph node metastasis of RC.

An unusual case of colon vascularization by the inferior mesenteric artery / Um caso incomum de vascularização do cólon pela artéria mesentérica inferior

Abstract In this article we present a rare variant in which the large intestine was vascularized by the inferior mesenteric artery. It was encountered during macro and microscopic dissection of the cadaver of a 63-year-old woman at a university department of human anatomy. In this case, the ascending, transverse, descending, and sigmoid colon and rectum were vascularized by the inferior mesenteric artery, whereas the small intestine, cecum and appendix were supplied by the superior mesenteric artery.

Resumo Neste artigo apresentamos uma variação rara em que o intestino grosso era vascularizado pela artéria mesentérica inferior. A variação foi descoberta durante a dissecção macro e microscópia de um cadáver do sexo feminino, 63 anos de idade, em um departamento universitário de anatomia humana. Neste caso, o cólon ascendente, transverso, descendente e sigmoide e também o reto eram vascularizados pela artéria mesentérica inferior, ao passo que o intestino delgado, ceco e apêndice eram vascularizados pela artéria mesentéria superior.

Surgical effect of laparoscopic anterior resection of rectal carcinoma with high ligate or low ligate inferior mesenteric artery: A Meta-analysis / 国际外科学杂志

Objective To evaluate the surgical effect of laparoscopic anterior resection of rectal carcinoma with or without the left colic artery.Methods Through computer searching PubMed,Cochrane Library,Embase,WanFang Date and CNIK Date.Handsearching the Gray literature simultaneously.The randomized controlled trails and clinical controlled trials comparing low ligation with high ligation the inferior mesenteric artery in laparoscopic anterior resection of rectal carcinoma were colected.Data were screened,extracted and evaluated by two reviewers independently.Meta-analyses were conducted using the sofeware STATE12.0.The standardized mean difference were calculated for continuous data and odds ratio for dichotomous and the point estimates of each effect quantity and 95％ confidence interval were calculated.TheI2 test was used to test the heterogeneity of the inchuded literature:if the heterogeneity was small,the fixed effects model was adopted.otherwise,the random effects models was adopted and explored the heterogeneity by sensitivity analysis or subgroup analysis.Results Forteen articles including 15 researches were met the selection criteria.The Meta-analyses showed that the grope of low ligation had lower rate of anastomotic fistula (OR =0.394,95 ％ CI:0.251-0.616,P =0.000) and longer opration time (SMD =0.361,95％CI:0.242-0.480,P =0.000).There is no statistical differences in the number of lymph node dissection besides the root of IMA (SMD =-0.017,95％ CI:-0.130-0.097,P =0.772) intraoperative biood loss (SMD =0.083,95 ％ CI:-0.048-0.214,P =0.213).Conclusions In spite of reserved the left colic artery had longer operation time it can reducedrate of anastomotic fistula effectively and there is no statistical differences in the number of lymph node dissection besides the root of IMA,intraoperative blood loss.It is possible to promote the use of reserved the left colic artery in laparoscopic anterior resection of rectal carcinoma.

Clinical analysis of saving the left colic artery feasibility in laparoscopic anterior resection of rectal carcinoma / 中国医师进修杂志

Objective To explore the feasibility and application value of saving the left colic artery (LCA) feasibility in laparoscopic anterior resection of rectal carcinoma (Dixon).Methods Collecting the clinical data of 63 patients diagnosed by rectal cancer and underwent laparoscopic anterior resection of rectal carcinoma from January 2009 to June 2012,including 32 cases underwent saving LCA (saving LCA group) and 31 cases not saving LCA (no saving LCA group).The amount of bleeding volume,operation time,the number of lymph node dissection of inferior mesenteric artery in the operation,pass wind time,anastomotic ischemia,anastomotic leakage,and recurrence and metastasis were compared.Results No significant difference was found in the bleeding volume [(62.82 ± 19.72) ml vs.(60.68 ± 21.39) ml],operation time [(129.48 ± 13.69) min vs.(129.45 ± 19.78) min],the number of lymph node dissection of inferior mesenteric artery in the operation (2.93 ± 1.54 vs.3.21 ± 1.30) between two groups (P ＞0.05).No significant difference was found in pass wind time [(2.82 ± 1.16) d vs.(3.14 ± 0.92) d] after operation (P ＞ 0.05).The saving LCA group was not performed freeing colon splenic area and the terminal ileum stoma,the proximal intestinal blood circulation disorder and anastomotic leakage were not found.In no saving LCA group,4 cases were underwent ileostomy because of the proximal intestinal blood circulation disorder,2 cases occurred anastomotic leakage.During the follow-up of 2-24 months,1 case had a recurrence,3 cases had metastasis in saving LCA group.1 case had a recurrence,4 cases had metastasis in no saving LCA group.Conclusion Saving LCA in Dixon operation can ensure the anastomotic part with adequate blood supply,and reduce the occurrence of anastomotic leakage.

Feasibility evaluation on preservation of left colonic artery in dealing with inferior mesenteric artery in laparoscopic anterior resection of rectal carcinoma / 中国医师进修杂志

Objective To explore the feasibility and value of preservation of left colonic artery (LCA) in dealing with inferior mesenteric artery (IMA) in laparoscopic anterior resection of rectal carcinoma.Methods The clinical data of 72 cases of laparoscopic anterior resection of rectal carcinoma from April 2010 to October 2013 were retrospectively analyzed including 32 cases with preservation of LCA (observation group) and 40 cases without preservation of LCA (control group).The blood loss,operative time,postoperative exhaust time,terminal ileum stoma,the number of lymph nodes removed around the root of IMA,the rate of lymph node metastasis around the root of IMA and prognosis were compared between two groups.Results There was no significant difference in the blood loss,operative time,postoperative exhaust time,terminal ileum stoma,the number of lymph nodes removed around the root of IMA,the rate of lymph node metastasis around the root of IMA between two groups (P ＞ 0.05).No case in observation group needed to free the splenic flexure of colon and to make the terminal ileum stoma,while 3 cases in control group needed to free splenic flexure of colon because of blood supply disorder in the proximal intestine (P =0.046),and 4 cases underwent terminal ileum stoma following anastomosis (P =0.042).No anastomotic leakage occurred in observation group,while 2 cases of anastomotic leakage occurred in control group(P =0.090).After followed up for 6-48 months,no significant difference was found in local recurrence and liver metastasis in two groups (P ＞ 0.05).Conclusion Laparoscopic anterior resection of rectal carcinoma with preservation of LCA in dealing with IMA can effectively retain the blood supply of proximal intestine.