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논문 기본 정보
- 자료유형
- 학술저널
- 저자정보
- 저널정보
- 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.97 No.2
- 발행연도
- 2019.8
- 수록면
- 74 - 82 (9page)
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Purpose: Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications. Colonic hypoperfusion can be induced by inferior mesenteric artery (IMA) ligation in some patients. This study aimed to evaluate atherosclerotic risk assessment and vascular parameters of CT angiography as predictors of colonic hypoperfusion.
Methods: This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as ＜0.4.
Results: Critically low MAP index (＜0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index.
Conclusion: Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery.
Methods: This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as ＜0.4.
Results: Critically low MAP index (＜0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index.
Conclusion: Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery.
목차
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
참고문헌 (30)
참고문헌 신청
Rao X / 2018 / Prognostic value of inferior mesenteric artery lymph node metastasis in cancer of the descending colon, sigmoid colon and rectum / Colorectal Dis 20:O135~O142
Kyung Ha Lee / 2018 / Feasibility and oncologic safety of low ligation of inferior mesenteric artery with D3 dissection in cT3N0M0 sigmoid colon cancer / 대한외과학회지 94(4):209~215
Park JS / 2013 / Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision : the Korean laparoscopic colorectal surgery study group / Ann Surg 257:665~671
Son GM / 2019 / Quantitative analysis of colon perfusion pattern using indocyanine green(ICG)angiography in laparoscopic colorectal surgery / Surg Endosc 33:1640~1649
Sindhu RS / 2017 / Low-tie IMA and selective D3 lymph node sampling in laparoscopic rectal resection for carcinoma rectum : comparison of surgical and oncological outcomes with the open technique / J Gastrointest Oncol 8:850~857
Kyung Ha Lee / 2018 / Feasibility and oncologic safety of low ligation of inferior mesenteric artery with D3 dissection in cT3N0M0 sigmoid colon cancer / 대한외과학회지 94(4):209~215
Park JS / 2013 / Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision : the Korean laparoscopic colorectal surgery study group / Ann Surg 257:665~671
Son GM / 2019 / Quantitative analysis of colon perfusion pattern using indocyanine green(ICG)angiography in laparoscopic colorectal surgery / Surg Endosc 33:1640~1649
Sindhu RS / 2017 / Low-tie IMA and selective D3 lymph node sampling in laparoscopic rectal resection for carcinoma rectum : comparison of surgical and oncological outcomes with the open technique / J Gastrointest Oncol 8:850~857
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UCI(KEPA) : I410-ECN-0101-2019-514-000942516