左半结肠切除术（英文）.doc

Laparoscopic sigmoidectomy for diverticulitis /en/165/02en165.php?ip=149997f849a8d1a5204cb95ff9a713d5 Symptomatic and complicated diverticular disease represents the most common indication for sigmoid colectomy in Western countries. As these resections are performed for benign disease, care must be taken to minimize any untoward sexual or urinary postoperative sequelae. A laparoscopic approach may be used to perform sigmoid resection in a manner equivalent to the open technique. In deed, most laparoscopists consider laparoscopic sigmoid colectomy relatively straightforward. However, the difficulty of the procedure increases significantly with complicated diverticular disease. The sigmoid colon is the mobile terminal portion of the left colon. Its mobility depends on the length of the sigmoid loop. The vascular supply of the sigmoid colon is based entirely on the inferior mesenteric artery and its branches. Thorough knowledge of the vascular anatomy and its variations is essential for a safe resection. The close proximity of the vessels to the left sympathetic trunk and the left ureter represent potential risks in sigmoid colon resection. Arteries The arteries are all branches of the inferior mesenteric artery (IMA). 1. Inferior mesenteric artery (IMA) 2. Left colic artery (LCA) 3. Trunk of sigmoid arteries 4. Superior rectal artery (SRA) 5. Marginal arteries Inferior mesenteric artery The inferior mesenteric artery (IMA) originates from the anterior surface of the abdominal aorta, 1 to 3 cm below the third portion of the duodenum, to form the main blood supply of the left colon. It gives off branches for the left colon, the sigmoid colon, and the rectum. Left colic artery The left colic artery (LCA) is the first branch of the IMA and supplies the vasculature of the left colon. After crossing over the inferior mesenteric vein (IMV), the LCA courses along the IMVs left border for a variable distance. It then approaches the marginal arteries, which it generally