术前三维CT血管成像评估肠系膜下动脉解剖特征

doi:10.13418/j.issn.1001-165x.2022.5.06

中国临床解剖学杂志 ›› 2022, Vol. 40 ›› Issue (5): 530-535.doi: 10.13418/j.issn.1001-165x.2022.5.06

术前三维CT血管成像评估肠系膜下动脉解剖特征

张鹏^1#，陈鑫^1#，张兰²，林曜¹，吕剑波¹，曾新宇¹，王征¹，李欣²，金曜³*，陶凯雄¹*

1. 华中科技大学同济医学院附属协和医院胃肠外科，武汉 430022； 2. 华中科技大学同济医学院附属
协和医院放射科，武汉 430022； 3. 华中科技大学附属医院外科，武汉 430074

收稿日期:2021-03-31 出版日期:2022-09-25 发布日期:2022-10-11
通讯作者: 金曜，E-mail: jinyao1024@hust.edu.cn；陶凯雄，教授，主任医师，博士研究生导师，E-mail: kaixiongtao@hust.edu.cn
作者简介:张鹏（1987-），湖北恩施人，主治医师，博士，主要从事消化道肿瘤的微创及规范化治疗， E-mail:zhangpeng_xt@163.com；共同第一作者：陈鑫（1996-），江西南昌人，华中科技大学同济医学院2014级临床医学专业，E-mail:hustchenxin@foxmail.com
基金资助:
国家自然科学基金（81702386、81874184、82072736）；湖北省卫生健康委员会重点项目（WJ2019Q030）

Anatomy of the inferior mesenteric artery evaluated by three-dimensional CT angiography before radical resection of rectal cancer

Zhang Peng^1#, Chen Xin^1#, Zhang Lan², Lin Yao¹, Lv Jianbo¹, Zeng Xinyu¹, Wang Zheng¹, Li Xin², Jin Yao³*, Tao Kaixiong¹*

1. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; 2. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; 3. Department of Surgery, Hospital Affiliated to Huazhong University of Science and Technology, Wuhan 430074, China

Received:2021-03-31 Online:2022-09-25 Published:2022-10-11

摘要/Abstract

摘要： 目的通过三维CT血管成像（CTA）评估分析直肠癌患者肠系膜下动脉（IMA）分型及解剖特点，为直肠癌手术血管处理提供参考。方法回顾分析2018年1月至2019年12月华中科技大学同济医学院附属协和医院接受IMA CTA检查的直肠癌患者临床及影像学资料。通过三维CT血管成像重建IMA图像。对IMA进行分类并测量统计肠系膜下血管各解剖参数。结果 266例研究对象中男性187例，女性79例。111例（41.7%）左结肠动脉（LCA）从主干独立发出，112例（42.1%）LCA和乙状结肠动脉（SA）共干发出，33例（12.4%）LCA、SA及直肠上动脉（SRA）共干，10例（3.8%）缺乏LCA。全组IMA主干长度（LIMA）为（39.1±10.1）mm、IMA根部至髂血管分叉距离（DIMA）为（44.1±7.4）mm、IMA根部与肠系膜下静脉（IMV）水平距离为（24.6±8.9）mm、IMA分支点与IMV水平距离为（13.0±5.3）mm。LCA走行包括：122例（47.6%）高位型，88例（34.4%）中位型，46例（18.0%）低位型。65例（25.4%）LCA紧贴IMV内侧，136例（53.1%）LCA紧贴IMV外侧，55例（21.5%）LCA外侧远离IMV。结论术前利用三维CT血管成像可准确评估IMA分型及肠系膜下血管的形态走行关系，为直肠癌手术中血管处理提供指导。

关键词: 直肠癌, , , 肠系膜下动脉, , , 三维CT血管成像, , , 血管变异

Abstract: Objective To evaluate and analyze the classification and anatomical characteristics of the inferior mesenteric artery (IMA) of patients with rectal cancer by three-dimensional CT angiography (CTA) in order to provide reference for the surgical management of rectal cancer. Methods A retrospective analysis was performed on the clinical and image data of rectal cancer patients received IMA CTA examinations in Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2018 to December 2019. IMA images were reconstructed by three-dimensional CT angiography. Branch types of IMA were classified, and anatomical parameters of the inferior mesenteric vessel were measured and analyzed. Results Among the 266 cases, 187 were males and 79 were females. The left colon artery (LCA) arose independently from the common trunk in 111 cases (accounting for 41.7%). In 112 cases (accounting for 42.1%), the LCA and sigmoid colon artery (SA) had a common trunk, and in 33 cases (accounting for 12.4%), LCA, SA and superior rectal artery (SRA) forked at same point, whereas LCA disappeared in 10 cases (accounting for 3.8%). The length of the IMA (LIMA) was (39.1±10.1) mm, and the distance between the IMA root and iliac aortic bifurcation (DIMA) was (44.1±7.4) mm. The distance from the IMA root to the inferior mesenteric vein (IMV) and the IMA branch point to the IMV were (24.6±8.9) mm, (13.0±5.3) mm, respectively. In 122 cases (accounting for 47.6%), LCA ascended medial to the lateral border of left kidney, while in 46 patients (accounting for 18.0%), LCA arranged below the inferior border of left kidney. LCA located medial to IMV at the level of IMA root in 65 cases (accounting for 25.4%), just lateral to IMV in 136 cases (accounting for 53.1%), and lateral away from IMV in 55 cases (accounting for 21.5%). Conclusions Three-dimensional CT angiography before surgery can accurately assess the IMA branch types and anatomical parameters of the inferior mesenteric vessel, which can provide reference for vascular management in rectal cancer surgery.

Key words: Rectal cancer, Inferior mesenteric artery, , , Three-dimensional CT angiography, , , Vascular variation

中图分类号:

R816.5

张鹏, 陈鑫, 张兰, 林曜, 吕剑波, 曾新宇, 王征, 李欣, 金曜, 陶凯雄. 术前三维CT血管成像评估肠系膜下动脉解剖特征[J]. 中国临床解剖学杂志, 2022, 40(5): 530-535.

Zhang Peng, Chen Xin, Zhang Lan, Lin Yao, Lv Jianbo, Zeng Xinyu, Wang Zheng, Li Xin, Jin Yao, Tao Kaixiong. Anatomy of the inferior mesenteric artery evaluated by three-dimensional CT angiography before radical resection of rectal cancer[J]. Chinese Journal of Clinical Anatomy, 2022, 40(5): 530-535.

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术前三维CT血管成像评估肠系膜下动脉解剖特征

Anatomy of the inferior mesenteric artery evaluated by three-dimensional CT angiography before radical resection of rectal cancer

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