頁籤選單縮合
| 題 名 | Unnecessary High Arterial Ligation in Colorectal Surgery May Proved by Inferior Mesenteric Artery Peeling=於大腸直腸手術中非必要性之高位動脈結紮術可由下腸繫膜動脈根部組織剝離術證明 |
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| 作 者 | 朱炳騰; 張敏琪; 王瑞和; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
| 卷 期 | 29:3 2018.09[民107.09] |
| 頁 次 | 頁126-132 |
| 分類號 | 416.245 |
| 關鍵詞 | 大腸直腸癌手術; 高位動脈結紮術; 根部組織剝離術; Colorectal surgery; High arterial ligation; Peeling; |
| 語 文 | 英文(English) |
| 中文摘要 | 目的:此回顧性研究是藉由研究從下腸繫膜動脈根部組織剝離術中取得的轉移性淋巴結陽性反應率,來探討在大腸直腸手術中高位結紥術本質上的必要性。方法:從2013年4月1日到2016年4月30日,在高雄榮民總醫院有216名患者分別被診斷為乙狀結腸癌及直腸癌,該患者們皆接受手術不論是剖腹或腹腔鏡的方式。排除單純接受高位結紮術,並無接受根部組織剝離術的患者後,最後有120位患者列入本研究當中。再依照癌症發生位置分成2組,分別有86名患者接受根部組織剝離術在大腸癌組及34名患者接受根部組織剝離術在直腸癌組。我們比較各組患者臨床病理特徵、剖腹或腹腔鏡方式根部組織剝離術得到的淋巴結的數目及從下腸繫膜動脈根部組織剝離術得到的淋巴結轉移的陽性反應率。結果:患者皆為接受剖腹或腹腔鏡方式的大腸直腸癌切除手術並在手術中接受下腸繫膜動脈根部組織剝離術。明顯的,利用腹腔鏡手術下取得的淋巴結數目多於用剖腹手術取得的淋巴結數目。然而即便從下腸繫膜動脈根部組織剝離術中可以穩定收穫到一定數量的淋巴結,在大腸癌組,其由下腸繫膜動脈根部組織剝離術中得到的淋巴結轉移陽性反應率為0%,又直腸癌組得到的淋巴結轉移陽性反應率為2.94%。 結論:從下腸繫膜動脈的起始處到左結腸動脈起始處下緣是一段很短的距離,從我們的研究中可以看出從此段下腸繫膜動脈週圍得到的淋巴結數目是極少的,又淋巴結轉移的陽性反應率也是極低。因此,在要承擔低血流灌注、吻合處滲漏及神經傷害的風險之下,不必要的高位結紮術是應該要被仔細考慮的。 |
| 英文摘要 | Purpose. This retrospective study investigated the necessary of nature of high ligation in colorectal surgery by positive rate of lymph nodes metastases from peeling of inferior mesenteric artery. Methods. Between April 1^(st), 2013 to April 30^(th), 2016, 216 patients were diagnosed with sigmoid colon, rectosigmoid colon and rectal cancer and received operation whether laparotomy or laparoscopic method at Kaohsiung Veterans General Hospital. After excluding patient with pure high ligation without peeling, 120 patients were enrolled in our study. Of the 120 patients, 86 patients were received peeling in colon cancer group and 34 patients were received peeling in rectal cancer group. After then, we compared clinicopatholgical characteristics of patients, number of retrieved lymph node from peeling and positive rate of lymph nodes metastases from peeling of inferior mesenteric artery in each group. Results. Patient received peeling of inferior mesenteric artery by laparotomy or laparoscopic colectomy. Obviously, the retrieved lymph nodes from peeling by laparoscopic operation are more than laparotomy operation. Even though steady harvested amount of lymph node from peeling of inferior mesenteric artery, there is still only 0% of positive rate of lymph nodes metastases from peeling in colon cancer group and 2.94% of positive rate of lymph nodes metastases from peeling in rectal cancer group. Conclusions. From origin of inferior mesenteric artery to location just below the origin of the left colic artery is a short distance and those extremely low numbers of retrieved lymph nodes and low incidence of positive rate of lymph nodes metastases around inferior mesenteric artery were revealed in our study. Therefore, the unnecessary of high arterial ligation should be considered due to it will undertake risks of low blood flow perfusion, leakage of anastomosis and damage of nerve. |
本系統中英文摘要資訊取自各篇刊載內容。