三维重建技术对肠系膜下动脉及左结肠动脉解剖变异的评估  

Evaluation of three-dimensional CT reconstruction on the anatomic variation of inferior mesenteric artery and left cofic artery

作　　者：蔡嘉伟[1] 温晓峰[1] 林伟星[1] 何真[1] 朱冬云[2] 邱建平[2] 孔德灿 何晓生[1] 何小文[1] 申泉 吴小剑[1] 兰平[1] 周智洋[2] 柯嘉[1] 

机构地区：[1]中山大学附属第六医院结直肠外科,广州510065 [2]中山大学附属第六医院外射科,广州510065 [3]北京思创贯宇科技开发有限公司,100048

出　　处：《中华胃肠外科杂志》2017年第11期1274-1278,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81770656、81402019）;中山大学青年教师培育项目（15ykpy30）

摘　　要：目的利用三维CT血管重建技术评估肠系膜下动脉（IMA）和左结肠动脉（LCA）的解剖特点及变异情况，以期为腹腔镜直肠或左半结肠切除术中的血管处理提供参考。方法回顾性分析中山大学附属第六医院2014—2015年间行全腹部多层螺旋CT检查的123例研究对象的临床及影像学资料，利用计算机三维血管重建技术对研究对象影像数据进行三维重建，并选取动脉增强期图像进行分析，测量IMA根部到腹主动脉分叉的直线距离及在IMA根部水平LCA至IMA根部的直线距离，并总结IMA分支类型、LCA走行规律及LCA与肠系膜下静脉（IMV）的位置毗邻关系。结果123例研究对象中男性80例，女性43例；年龄（46.8± 16.6）岁；身高（164.6± 7.9）cm，体质量（57.7± 10.4）kg，体质指数（21.3± 3.6）kg/m2。IMA根部至腹主动脉分叉的平均距离为（42.5 ± 7.9）mm，该距离长短与体质量关系密切（OR = 4.771，95%CI：1.398-16.283，P = 0.013）；61例（49.6%）IMA单独发出LCA和乙状结肠动脉（SA），35例（28.5%）LCA与SA在同一点分支，24例（19.5%）LCA与SA共干发出后再分支，3例（2.4%）LCA缺如。LCA发出后沿高位内侧走行者71例（57.7%），沿中位走行者33例（26.8%），走行于低位外侧者16例（13.0%）；LCA走行位置越高，其越靠近IMA根部[LCA至IMA根部的水平距离分别为（24.2 ± 9.9）mm、（30.0 ± 15.2）mm和（66.6 ± 12.3）mm，F = 83.2，P 〈 0.001]。在IMA根部水平，21例（17.1%）LCA出现在肠系膜下静脉（IMV）内侧，54例（43.9%）紧贴IMV外侧，48例（39.0%）在IMV外侧并远离IMV上行。结论CT三维血管重建技术能准确评估患者IMA及其分支的走形特点及变异情况，为术中决策提供重要参考，从而令腹腔镜手术更加安全顺畅。Objective To demonstrate the clinical applicability of three-dimensional CT angiography by evaluating the anatomic features and variation of inferior mesenteric artery（IMA） and left colic artery （LCA） in order to provide reference to vessel ligation strategy in laparoscopic rectal cancer surgery. Methods Clinical and image data of 123 patients receiving abdominal muhislice CT at The Sixth Affiliated Hospital from 2014 to 2015 were retrospectively analyzed. The images were 3D- reconstructed with computer 3D CT angiography and arterial enhancement phase images were chosen for analysis. Linear distances from IMA root to abdominal aortic bifurcation and from LCA at IMA root level to IMA root were measured. Branch types of IMA, coursing pattern of LCA, and association between LCA and inferior mesenteric vein （IMV） site were summarized. Results Of 123 cases, 80 were males and 43 were females, mean age was （46.8 ± 16.6） years, body weight was （57.7 ± 10.4） kg, and BMI was （21.3 ± 3.6） kg/m2. The average distance from IMA root to abdominal aortic bifurcation was （42.5 ± 7.9） ram, and this distance was closely associated with body weight （OR = 4.771, 95%CI： 1.398 to 16.283, P=0.013）. Longer distance tended to appear in the heavier patients. LCA and sigmoid artery （SA） originating from same single IMA was found in 61 （49.6%） cases; LCA and SA forking at same point in 35 （28.5%） cases; LCA and SA coursing together and forking afterwards in 24 （19.5%） cases, and LCA disappearing in 3 （2.4%） cases. In 71 （57.7%） patients, LCA ascended medial to the lateral border of left kidney, while in 16 （13.0%） patients, LCA arranged below the inferior border of left kidney. When the LCA site was higher and the distance from LCA to IMA root was closer [ distance from LCA to IMA root level was （24.2 ± 9.9） ram, （30.0 ± 15.2） mm and （66.6 ± 12.3） mm, F = 83.2, P 〈 0.001]. At the level of IMA root, LCA located medial to IMV in 21 （17.1%） cases, located jus

关 键 词：腹腔镜手术 肠系膜下动脉 左结肠动脉 三维血管重建 

分 类 号：R735.37[医药卫生—肿瘤]