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目的探讨不同乙状结肠系膜粘连分型对腹腔镜低位直肠癌前切术手术方式的临床意义。方法回顾性分析114例低位直肠癌手术患者乙状结肠系膜粘连形态,统计Ⅰ型、Ⅱ型和Ⅲ型乙状结肠长度、系膜长度、系膜边缘血管弓距肠壁的距离、系膜根部距边缘血管弓的距离及系膜附着点距离,同时统计离断系膜根部血管后系膜边缘血管弓的血供及术后吻合口瘘的情况。结果乙状结肠肠管长度Ⅰ型为(47.8±4.5)cm,Ⅱ型为(34.6±2.1)cm,Ⅲ型为(30.4±3.7)cm;系膜长度Ⅰ型为(13.8±2.1)cm,Ⅱ型为(8.9±1.3)cm,Ⅲ型为(11.2±1.5)cm;系膜根部距边缘血管弓的距离Ⅰ型为(11.8±2.0)cm,Ⅱ型为(7.2±1.8)cm,Ⅲ型为(9.4±1.1)cm。Ⅰ型、Ⅱ型和Ⅲ型之间乙状结肠长度、系膜长度、系膜根部距边缘血管弓的距离之间存在明显差异性,离断肠系膜下动脉根部血管后,Ⅰ型边缘血管弓血供最好,Ⅱ、Ⅲ型血供较差,Ⅰ型未出现吻合口瘘,Ⅱ型、Ⅲ型各3例吻合口瘘发生。结论注意乙状结肠系膜粘连分型可提高腹腔镜下低位直肠癌前切术的安全性。
Objective To investigate the clinical significance of different types of sigmoid mesentery adhesions for laparoscopic low rectal cancer surgery. Methods The sigmoid mesangial adhesions were retrospectively analyzed in 114 patients with low rectal cancer. The lengths of type I, type II and type III sigmoid, the length of mesentery, the distance between the medullary vessels and the intestinal wall, and the distance from the mesangial root to the marginal vessels were counted. The distance between the bow and the distance of the mesangial attachment point, and the blood supply of the vascular arch from the posterior mesenteric edge and the postoperative anastomotic leakage were counted. Results The sigmoid colon length I was (47.8±4.5) cm, type II was (34.6±2.1) cm, type III was (30.4±3.7) cm; mesangial length type I was (13.8±2.1) cm, type II was (8.9 ± 1.3) cm, type III is (11.2 ± 1.5) cm; the distance from the root of the mesangial root to the edge of the vascular arch is (11.8 ± 2.0) cm, type II is (7.2 ± 1.8) cm, and type III is ( 9.4±1.1)cm. The length of the sigmoid, the length of the mesentery, and the distance from the root of the mesangium to the edge of the vascular arch were significantly different between type I, type II, and type III. From the root vessels of the inferior mesenteric artery, the blood supply of the type I marginal vascular arch was the most common. Well, type II, III blood supply is poor, type I did not appear anastomotic leakage, type II, type III and 3 cases of anastomotic leakage occurred. Conclusion Careful attention should be paid to the safety of laparoscopic low rectal cancer anterior resection in the diagnosis of sigmoid mesenteric adhesions.