肠系膜下血管的腔镜下解剖学观察  

Laparoscopic observation of the anatomy of inferior mesenteric artery

作　　者：张策[1] 李国新[1] 丁自海[2] 黄祥成[1] 钟世镇[2] 

机构地区：[1]南方医科大学南方医院普通外科,广州市510515 [2]南方医科大学微创外科解剖学研究所,广州市510515

出　　处：《实用医学杂志》2012年第15期2525-2528,共4页The Journal of Practical Medicine

基　　金：广东省自然科学基金(编号:07300474);广东省科技计划项目(编号:2008A030201017);南方医院院长基金(编号:2011Z010)

摘　　要：目的:阐明肠系膜下动脉(inferior mesenteric artery,IMA)和肠系膜下静脉(inferior mesenteric vein,IMV)的腔镜下解剖学特点,以指导腔镜下血管定位。方法:解剖和观察15具尸体;对126例接受腹腔镜左侧结肠癌和直肠癌手术的患者进行术中观察和术后录像复习。结果:IMA起自腹主动脉前壁,起点大部分平L3椎体或L3-4椎间盘,与主动脉分叉距离(42.08±6.26)mm;IMA分支有多种变异。腔镜下:系膜前,IMA表现为自主动脉前面向左下走行、乙状结肠系膜内隆起并搏动的条索;系膜后,IMA主干位于结肠系膜偏后部,IMA根部是左结肠后间隙内的固有障碍。在左髂总动脉水平,IMA位于左输尿管、左性腺血管内侧,三者位置关系恒定。IMA根部神经纤维分布少。IMV走行于IMA左侧的结肠系膜内,末段与动脉分离后,经十二指肠空肠襞左缘后方进入胰体后面。结论:正确的外科间隙(左结肠后间隙)、标志、外观和线索,是腹腔镜下IMA和IMV定位的解剖学基础。Objective To explore the laparoscopic anatomical characteristic of inferior mesenteric artery （IMA） and inferior mesenteric vein （IMV）. Methods 15 cadavers were dissected and observed. 126 patients undergoing laparoscopic left colon cancer and rectal cancer were observed. Results The origin of IMA was located at the anterior surface of abdominal aorta, was （42.08 ± 6.26）mm proximal to aortic bifurcation, mostly at the level of the 3rd lumbar vertebra or intervertebral disc. There were variations of the branches of IMA. In laparoscopic view, IMA was pulsatory strips in sigmoid mesocolon, originating from anterior wall of abdominal aorta and running left and inferiorly. Posterior to left mesocolon, the trunk of IMA was located at posterior part of mesocolon, and the origin of IMA was the obstacle in left retrocolic space. At the level of left common iliac artery, IMA was medial to left ureter and left gonadal vessel. Little nerve fibers were seen around the origin of IMA. IMV ran in mesocolon left to IMA. The end part of IMV was not accompanied by IMA and ran posteriorly to left margin of dnodenojejunal fold, before going posteriorly to pancreas body. Conclusion Right surgical spaces （left retrocolic space）, landmarks, appearance, and clues are anatomical basis for the localization of IMA and IMV under laparoscopy.

关 键 词：解剖 肠系膜下动脉 肠系膜下静脉 腹腔镜 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R657.2[医药卫生—基础医学]