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中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (04) : 297 -302. doi: 10.3877/cma.j.issn.2095-3224.2022.04.005

论著

肠系膜下动脉解剖分型在肠系膜下动脉结扎方式选择中的应用
杨俊1, 张伟克1, 金纬1, 林卓群1, 李绍堂1,()   
  1. 1. 325000 温州医科大学附属第一医院结直肠肛门外科
  • 收稿日期:2022-02-10 出版日期:2022-08-25
  • 通信作者: 李绍堂
  • 基金资助:
    浙江省自然科学基金华东医药企业创新发展联合基金资助项目(LHDMY22H160002)

The application of inferior mesenteric artery anatomical classification in the selection of inferior mesenteric artery ligation

Jun Yang1, Weike Zhang1, Wei Jin1, Zhuoqun Lin1, Shaotang Li1()   

  1. 1. Department of Coloproctological Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
  • Received:2022-02-10 Published:2022-08-25
  • Corresponding author: Shaotang Li
引用本文:

杨俊, 张伟克, 金纬, 林卓群, 李绍堂. 肠系膜下动脉解剖分型在肠系膜下动脉结扎方式选择中的应用[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(04): 297-302.

Jun Yang, Weike Zhang, Wei Jin, Zhuoqun Lin, Shaotang Li. The application of inferior mesenteric artery anatomical classification in the selection of inferior mesenteric artery ligation[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(04): 297-302.

目的

探讨肠系膜下动脉(IMA)各种解剖分型及血管长度差异的相关因素,为结直肠癌低位结扎IMA提供参考。

方法

前瞻性收集温州医科大学附属第一医院2019年7月至2020年4月因乙状结肠癌及直肠癌接受根治性手术治疗的患者的病例资料,术前使用增强CT对IMA进行重建,对IMA分型进行统计分析。并选取温州医科大学解剖教研室10具成人尸体,进行IMA解剖。

结果

共纳入172例血管充盈可,重建效果佳的患者数据,纳入统计。按照Murono分型标准,其中Ⅰ型88例,Ⅱ型66例,Ⅲ型16例,Ⅳ型患者2例(不纳入后续统计分析)。170例患者中,IMA主干长(42.96±6.78)mm,体重是IMA主干长的主要影响因素(系数=0.253,P<0.05),IMA主干长度=23.12+0.253×体重(R2=0.181)。体重每增加一个单位(kg),长度平均增加0.253个单位(mm)。

结论

对IMA术前行增强CT可以了解IMA分型,有助于低位结扎位置的选择。可通过体重对IMA血管长度进行预估,从而选择最合适的血管处理方式。

Objective

To explore various anatomical types and vascular length related factors of inferior mesenteric artery (IMA), and to provide a reference for lower ligation of IMA for colorectal cancer.

Methods

The patients who received surgery for colorectal cancer in the First Affiliated Hospital of Wenzhou Medical University from July 2019 to April 2020 were retrospectively analyzed. IMA imaging of inferior mesenteric artery was performed with enhanced CT before operation, and the IMA classification was statistically summarized. In addition, ten adult cadavers from Wenzhou Medical University were dissected by IMA.

Results

There were 172 patients with good filling and good reconstruction effect. According to Murono classification criteria, eighty-eight cases were type Ⅰ, sixty-six cases were type Ⅱ, and 16 cases were type Ⅲ. There were 2 type Ⅳ patients (not included in the statistics). The length of IMA trunk was (42.96±6.78)mm, and there was a certain degree of linear relationship between body weight and IMA trunk length, so body weight was the main influencing factor (coefficient=0.253, P<0.05). The final equation is IMA trunk length=23.12+0.253×body weight (R2=0.181). The regression equation showed that body weight was positively correlated with IMA dry length, and the average length increased by 0.253 units (mm) for each unit (kg) increase of body weight.

Conclusion

Enhanced CT for IMA can clarify the classification of IMA and the specific vascular conditions, which is helpful to select the location of low ligation. The length of blood vessels can be estimated by BMI, so as to provide the most appropriate way of vascular treatment.

图1 肠系膜下动脉血管Murono分型示意图
表1 170例患者临床资料(例,%)
图2 IMA血管重建及尸体解剖分型。2A:Murono Ⅰ型患者IMA血管重建及尸体解剖,2B:Murono Ⅱ型患者IMA血管重建及尸体解剖,2C:Murono Ⅲ型患者IMA血管重建及尸体解剖,2D:Murono Ⅳ型患者IMA血管重建
表2 血管长度与各因素的相关系数
表3 IMA主干与身高体重多元线性回归表
[1]
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2018, 68(6): 394-424.
[2]
Yada H, Sawai K, Taniguchi H, et al. Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer [J]. World J Surg, 1997, 21(1): 109-115.
[3]
Benson AB, Venook AP, Al-Hawary MM, et al. Rectal Cancer, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology [J]. J Natl Compr Canc Netw, 2018, 16(7): 874-901.
[4]
Murono K, Kawai K, Kazama S, et al. Anatomy of the inferior mesenteric artery evaluated using 3-dimensional CT angiography [J]. Dis Colon Rectum, 2015, 58(2): 214-219.
[5]
Battal B, Hamcan S, Akgun V, et al. Congenital superior-inferior mesenteric arterial variation or arc of Riolan due to occlusion of proximal superior mesenteric artery [J]. Surg Radiol Anat, 2014, 36(3): 309-310.
[6]
Lowry AC, Simmang CL, Boulos P, et al. Consensus statement of definitions for anorectal physiology and rectal cancer [J]. Colorectal Dis, 2001, 3(4): 272-275.
[7]
Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer [J]. Int J Clin Oncol, 2020, 25(1): 1-42.
[8]
Fujii S, Ishibe A, Ota M, et al. Short-term and long-term results of a randomized study comparing high tie and low tie inferior mesenteric artery ligation in laparoscopic rectal anterior resection: subanalysis of the HTLT (High tie vs. low tie) study [J]. Surg Endosc, 2019, 33(4): 1100-1110.
[9]
Cirocchi R, Trastulli S, Farinella E, et al. High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a RCT is needed [J]. Surg Oncol, 2012, 21(3): e111-123.
[10]
Pandey D. Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery [J]. Br J Surg, 2006, 93(8): 1023.
[11]
Dworkin MJ, Allen-Mersh TG. Effect of inferior mesenteric artery ligation on blood flow in the marginal artery-dependent sigmoid colon [J]. J Am Coll Surg, 1996, 183(4): 357-360.
[12]
Kobayashi M, Morishita S, Okabayashi T, et al. Preoperative assessment of vascular anatomy of inferior mesenteric artery by volume-rendered 3D-CT for laparoscopic lymph node dissection with left colic artery preservation in lower sigmoid and rectal cancer [J]. World J Gastroenterol, 2006, 12(4): 553-555.
[13]
Komen N, Slieker J, de Kort P, et al. High tie versus low tie in rectal surgery: comparison of anastomotic perfusion [J]. Int J Colorectal Dis, 2011, 26(8): 1075-1078.
[14]
Trencheva K, Morrissey KP, Wells M, et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients [J]. Ann Surg, 2013, 257(1): 108-113.
[15]
Hida J, Okuno K. High ligation of the inferior mesenteric artery in rectal cancer surgery [J]. Surg Today, 2013, 43(1): 8-19.
[16]
Bertrand MM, Delmond L, Mazars R, et al. Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branches [J]. Surg Radiol Anat, 2014, 36(10): 1057-1062.
[17]
Yi SQ, Li J, Terayama H, et al. A rare case of inferior mesenteric artery arising from the superior mesenteric artery, with a review of the review of the literature [J]. Surg Radiol Anat, 2008, 30(2): 159-165.
[18]
Silberhumer GR, Paty PB, Temple LK, et al. Simultaneous resection for rectal cancer with synchronous liver metastasis is a safe procedure [J]. Am J Surg, 2015, 209(6): 935-942.
[19]
周家铭, 谭淑云, 黄俊, 等. 根据肠系膜下动脉各分支分型行精准低位结扎并根部淋巴结清扫的腹腔镜直肠癌根治术[J]. 中华胃肠外科杂志, 2018, 21(1): 46-52.
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