gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1280Research ArticleНОВОСТИ КОЛОПРОКТОЛОГИИNEWS OF COLOPROCTOLOGYСкелетизация нижней брыжеечной артерии с парааортальной лимфаденэктомией в лечении рака левой половины ободочной кишкиInferior mesenteric artery skeletization with para-aortic lymphadenectomy in the treatment of left-sided colon cancerЦарьковП. В.TsarkovP. V.КравченкоА. Ю.KravchenkoA. Yu.ТулинаИ. А.TulinaI. A.БашанкаевБ. Н.BashankayevB. N.СамофаловаО. Ю.SamofalovaO. Yu.Российский научный центр хирургии им. Б.В. Петровского РАМНRussian Federation2012170420122226070Copyright © Царьков П.В., Кравченко А.Ю., Тулина И.А., Башанкаев Б.Н., Самофалова О.Ю., 20122012Царьков П.В., Кравченко А.Ю., Тулина И.А., Башанкаев Б.Н., Самофалова О.Ю.Tsarkov P.V., Kravchenko A.Y., Tulina I.A., Bashankayev B.N., Samofalova O.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1280

Цель исследования. Разработка и оценка эффективности онкологически обоснованных и безопасных методов хирургических вмешательств для различных локализаций и стадий рака левой половины ободочной кишки.Материал и методы. С февраля 2008 по май 2011 г. отобраны 59 больных раком левых отделов ободочной кишки. Всем пациентам выполнена резекция кишки в различном объеме с парааортальной лимфодиссекцией и скелетизацией нижнебрыжеечной артерии (методика подробно описана) – 11 левосторонних гемиколэктомий, 14 резекций левых отделов, 13 дистальных и 21 сегментарная резекция сигмовидной ободочной кишки.Результаты. Наибольшая длительность операции (250,9±71,5 мин) и объем интраоперационной кровопотери (745,4±737,0 мл) наблюдались при выполнении левосторонней гемиколэктомии, продолжительность других вмешательств не превышала 3 ч, а кровопотеря при них была не более 250 мл. Послеоперационные осложнения возникли у 9 больных. Среднее число исследованных лимфатических узлов в удаленных препаратах составило 26,4±18,2. Наиболее часто отмечалось метастатическое поражение параколических лимфоузлов, у2 больных выявлены пораженные апикальные лимфоузлы. Трехлетняя кумулятивная выживаемость составила 93%.Заключение. Применяемая техника скелетизации нижнебрыжеечной артерии позволяет выполнить обширную парааортальную лимфодиссекцию и сохранить питающие сосуды. За счет этого значительно снижается число левосторонних гемиколэктомий в пользу сегментарных резекций. Описанные вмешательства безопасны с точки зрения послеоперационных осложнений и характеризуются хорошими онкологическими результатами.

Aim of investigation

Aim of investigation. Development and efficacy evaluation of oncologically proved and safe surgical methods for various locations and stages of left-sided colon cancer.

Material and methods

Material and methods. Overall 59 patients with left-sided colon cancer were selected from February, 2008 to May, 2011. All patients underwent bowel resection in different volume with para-aortic lymph node dissection and skeletization of inferior mesenteric artery (detailed description of the procedure is presented): 11 left-side hemycolectomies, 14 partial resections of the left colon, 13 distal and 21 segmentary resection of sigmoid colon were executed.

Results

Results. The highest duration of operation (250,9±71,5 min) and volume of intraoperative blood loss (745,4±737,0 ml) was observed at left-side hemicolectomy, duration of other interventions did not exceed 3 h, and the blood loss – was less than 250 ml. Postoperative complications developed in 9 patients. The mean number of investigated lymph nodes in resected speciemens was 26,4±18,2. Metastatic involvement was most frequent in paracolic lymph nodes, affected apical lymph nodes are revealed in 2 cases. Cumulative three-year survival rate was 93%.

Conclusion

Conclusion. Applied technique of inferior mesenteric artery skeletization allows to carry out extensive para-aortic lymph node dissection and to keep supplying vessels. This allows to decrease considerably the number of left-side hemicolectomies for segmentary resections. Presented interventions are safe from the point of postoperative morbidity and are characterized by good oncologic results.

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The authors declare that there are no conflicts of interest present.