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直肠癌低位前侧切除术时,结肠血管的处理有两种方法,一是在主动脉旁高位结扎肠系膜下动脉(以下简称主动脉旁结扎),尤适用于肠系膜下动脉周围淋巴结已有浸润者;另一种是保留结肠左动脉上升支(ALCA),对结肠血供较好,但妨碍脾曲的充分游离。作者在连续143例直肠癌低位前则切除术观察两种血管处理方法的结果。肿瘤平均距肛缘7cm,均充分游离脾曲和降结肠,用吻合器吻合结肠和直肠,吻合口距肛缘4.5 cm。全组143例中,52例保留 ALCA91例行主动脉旁结扎。还做了101例预防性结肠袢式造瘘术,其中主动脉旁结扎和 ALCA 保留分别占60例和40例;余42例未做预防性结肠造瘘术,其中
In the low frontal resection of rectal cancer, there are two methods for treatment of colonic vasculature. First, the inferior mesenteric artery is ligated next to the aorta (hereinafter referred to as the aortic paracerebral artery ligation), and it is particularly suitable for infiltrating lymph nodes around the inferior mesenteric artery. The other is to keep the left ascending branch of the colon (ALCA), better blood supply to the colon, but hinder the full release of splenic flexure. The authors performed consecutive low-level resection of rectal cancer in 143 consecutive cases to observe the results of the two vascular treatment methods. The average distance between the tumor and the anal margin was 7cm. The spleen curve and the descending colon were fully freed. The anastomosis was used to anastomose the colon and rectum. The anastomotic distance was 4.5 cm from the anal margin. Of the 143 patients in the entire group, 52 patients retained ALCA 91 for aortic ligation. 101 cases of prostatic colostomy were also performed, including 60 cases of aortic paralysis and ALCA retention and 40 cases of ALCA retention; the remaining 42 cases were not treated with prophylactic colostomy.