腹盆腔增强CT对肠系膜下血管和输尿管的评估及对腹腔镜直肠手术的指导意义  

Evaluation of inferior mesenteric vessel and ureter by contrast-enhanced abdominal pelvic CT and its clinical influence on laparoscopic rectal surgery

作　　者：左帅[1] 王可[2] 李建辉[2] 安航 郭小超[2] 汪欣[1] Zuo Shuai;Wang Ke;Li Jianhui;An Hang;Guo Xiaochao;Wang Xin(Department of General Surgery,Peking University First Hospital,Beijing 100034,China;Department of Medical Radiography,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院普通外科,100034 [2]北京大学第一医院影像科,100034

出　　处：《中华胃肠外科杂志》2020年第3期294-299,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：北京大学第一医院青年临床研究专项(2017CR19)。

摘　　要：目的利用腹盆腔增强CT评估肠系膜下动静脉(IMA和IMV)与输尿管的关系特点,为腹腔镜直肠手术血管处理及输尿管保护提供指导。方法采用回顾性队列研究的方法。病例纳入2018年11月1—30日于北京大学第一医院影像科行腹盆腔增强CT检查的患者;排除标准:(1)既往有腹盆腔手术史;(2)脊柱侧弯畸形;(3)图像缺失;(4)未成年人;(5)肠系膜下血管病变或受肿瘤累及致显示不清;(6)图像质量差。最终249例腹盆腔增强CT资料纳入研究,男性120例(48.2%),年龄(60.1±13.4)岁。利用多平面重组(MPR)和最大密度投影(MIP)对IMA、IMV及输尿管的解剖关系进行评估。测量IMA根部位置,IMA长度及主要分支间距离,IMA、IMV与输尿管在IMA根部、左结肠动脉(LCA)根部、腹主动脉分叉、骶骨岬层面间距离,总结IMA、IMV与输尿管位置关系特点。结果IMA根部距主动脉分叉和骶骨岬距离分别为(42.0±8.5)mm和(101.8±14.0)mm,IMA长度为(38.5±10.7)mm。IMA根部位置位于第2、3、4腰椎水平比例分别为3.2%(8/249)、79.5%(198/249)和17.3%(43/249);腰椎水平越高、IMA长度越长,差异有统计学意义[第2腰椎水平(42.4±10.9)mm比第3腰椎水平(39.5±10.4)mm比第4腰椎水平(33.0±10.9)mm,F=7.48,P<0.001]。111例(44.6%)LCA单独发自IMA(1型),LCA与乙状结肠动脉(SA)第一支距离为(15.0±7.4)mm;56例(22.5%)LCA与SA共干后分支(2型),共干长度为(11.0±8.5)mm;78例(31.3%)LCA与SA在同一点分支(3型);4例(1.6%)LCA缺如(4型)。LCA缺如型IMA长度为(54.8±18.0)mm,长于LCA型IMA长度(38.2±10.5)mm,差异有统计学意义(t=3.110,P=0.002)。位于IMA根部水平的输尿管到IMA的距离最长[(35.7±8.1)mm],位于主动脉分叉水平的输尿管到IMA的距离最短[(22.4±6.4)mm],不同平面输尿管与其到IMA之间的距离差异有统计学意义(F=185.70,P<0.001)。位于骶骨岬水平的输尿管到IMV的距离最长[(21.1±9.0)mm],位于LCA根部水平的输尿管到IMV的距离最短[(12.0±5.7)mmObjective To assess the anatomic relationship of inferior mesenteric artery(IMA)/inferior mesenteric vein(IMV)with ureter by contrast-enhanced abdominal pelvic CT,in order to provide guidance for vascular management and ureteral protection in laparoscopic rectal surgery.Methods A retrospective cohort study was conducted.Image data of contrast-enhanced abdominal pelvic CT at Department of Medical Radiography of Peking University First Hospital in November 2018 were enrolled.Exclusion criteria:(1)previous history of abdominal or pelvic surgery;(2)scoliosis deformities;(3)missing images;(4)minors;(5)inferior mesenteric vascular disease or tumor involvement resulting in suboptimal imaging;(6)poor image quality.Finally,contrast-enhanced abdominal pelvic CT data of 249 cases were collected,including 120 males and 129 females with mean age of(60.1±13.4)years.Multi-planar reconstruction(MPR)and maximum intensity projection(MIP)were used to evaluate the anatomic relationship of IMA/IMV with ureter.IMA root location,IMA length,branch types of IMA,distance between major branches,distance between IMA/IMV and ureter at the level of root of IMA,left colic artery(LCA)root,abdominal aortic bifurcation,and sacral promontory were measured and association between IMA/IMV and ureter site was summarized.Results The distance from IMA root to the aortic bifurcation and sacral promontory was(42.0±8.5)mm and(101.8±14.0)mm,respectively.The length of IMA was(38.5±10.7)mm.The proportion of IMA roots locating at levels of the 2nd,3rd,and 4th lumbar vertebra was 3.2%(8/249),79.5%(198/249),and 17.3%(43/249),respectively.The higher the level of the lumbar vertebra,the longer the IMA[length of IMA originating from the 2nd,3rd,4th lumbar vertebra level:(42.4±10.9)mm,(39.5±10.4)mm,(33.0±10.9)mm,respectively;F=7.48,P<0.001].In 111 cases(44.6%),LCA arose independently from IMA(type 1),and the distance between LCA and the first branch of sigmoid artery(SA)was(15.0±7.4)mm;in 56 cases(22.5%),LCA and SA had a common trunk(type 2),with a length o

关 键 词：肠系膜下动脉 输尿管 CT 腹腔镜手术 

分 类 号：R656[医药卫生—外科学] R81[医药卫生—临床医学]