肠系膜下动脉血管分型及Riolan动脉弓缺如对腹腔镜直肠癌根治术后吻合口瘘发生率的影响  

Influences of inferior mesenteric artery types and Riolan artery arcade absence on the incidence of anastomotic leakage after laparoscopic resection of rectal cancer

作　　者：黄俊[1] 周家铭[1] 万英杰[2] 林杨皓 邓艳红[1] 周智洋[1] 邱建平[1] 汪建平[1] 黄美近[1] 

机构地区：[1]中山大学附属第六医院结直肠外科,广州510655 [2]江西省抚州市第一人民医院检验科,344000

出　　处：《中华胃肠外科杂志》2016年第10期1113-1118,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨肠系膜下动脉（IMA）分型及Riolan动脉弓缺如对腹腔镜直肠癌根治术后吻合口瘘发生率的影响。方法回顾性分析中山大学附属第六医院2012年1月至2014年12月间行腹腔镜直肠癌根治术的116例局部进展期直肠癌患者的临床资料。根据术前腹盆腔增强CT血管造影（CTA），对IMA分支进行分型并判断Riolan动脉弓是否存在，并采用逻辑回归模型分析IMA分型、Riolan动脉弓缺如及IMA结扎部位（高位或低位）对吻合口瘘发生率的影响。结果116例患者中IMAⅠ型67例（57．8％），Ⅱ型12例（10．3％），Ⅲ型36例（31．0％），Ⅳ型1例（0．9％）。Riolan动脉弓缺如比例为60．3％（70／116）。术后8例（6．9％）患者出现吻合口瘘，IMAm型患者吻合口瘘发生率明显高于其他分型者[19．4％（7／36）比1．2％（1／80），P=0．001]，Riolan动脉弓缺如者吻合口瘘发生率亦明显增高[11．4％（8／70）比0％（0／46），P=0．030]；而IMA高位与低位者术后吻合口瘘发生率的差异则无统计学意义[8．0％（7／87）比3．4％（1／29），P=0．531]。8例吻合口瘘中有7例发生于IMAHⅠ型且Riolan动脉弓缺如并行IMA高位结扎的患者。多因素分析结果显示，IMAⅢ型（P=0．001）和Riolan弓缺如（P=0．002）是吻合口瘘发生的独立危险因素。结论IMAⅢ型及Riolan动脉弓缺如的直肠癌患者术后吻合口瘘发生率显著增高。IMA分型和Riolan动脉弓存在与否有助于术中IMA结扎位置的选择。对于IMAⅢ型并Riolan动脉弓缺如患者．可考虑行低位结扎加高选择性淋巴结清扫。Objective To evaluate the influences of inferior mesenteric artery （IMA） types and Riolan artery arcade absence on the incidence of anastomotic leakage （AL） after laparoscopic resection of rectal cancer. Methods Clinical data of 116 local advanced rectal cancer patients who underwent laparoscopic resection in The Sixth Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2014 were analyzed retrospectively. IMA and Riolan artery arcade were examined by preoperative computed tomography angiography （CTA） reconstruction. The influences of IMA type,Riolan artery arcade absence and ligation site （high or low） on AL were analyzed by Logistic regression. Results The proportion oflMA types（ Ⅰ -Ⅳ） was 57.8%（67/116）, 10.3%（12/116）, 31.0%（36/116） and 0.9%（1/116）, respectively. Riolan artery arcade absence was found in 60.3% （70/116）. Eight （6.9%） patients suffered from AL. IMA type Ⅲ had significantly higher AL incidence as compared to other IMA types [ 19.4%（7/36） vs. 1.2%（1/80）, P = 0.001 ]. Meanwhile, patients with Riolan artery arcade absence also had significantly higher AL incidenee[11.4%（8/70）vs. 0.0%（0/ 46）, P = 0.030]. However, the difference in AL incidence between high and Low IMA ligation was not statistically significant [8.0%（7/87） vs. 3.4%（1/29）, P = 0.531]. Seven of these 8 AL patients were found in IMA type Ⅲ with Riolan artery arcade absence and high ligation. Multivariate analysis showed that IMA type Ⅲ（P = 0.001） and Riolan artery arcade absence （P = 0.002） were independent risk factors of AL. Conclusions IMA type Ⅲ with Riolan artery arcade absence increases AL incidence significantly in laparoseopic resection of rectal cancer. IMA type and Riolan aretry arcade absence or not contribute to the selection of IMA ligation site in the operation. For the coloreetal cancer patients with IMA type Ⅲ and Riolan artery arcade absence, selective low IMA ligation with root lymph node dissection should be

关 键 词：直肠肿瘤 肠系膜下动脉 血管分型 Riolan动脉弓 吻合口瘘 

分 类 号：R735.37[医药卫生—肿瘤]