经肛视角直肠中动脉的出现率与解剖学特征分析  

Analysis of the incidence and anatomical features of the middle rectal artery through the transanal perspective

作　　者：顾磊[1] 蒋春晖[1] 刘晔[1] 徐庆[1] GU Lei;JIANG Chunhui;LIU Ye;XU Qing(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127

出　　处：《中国普通外科杂志》2023年第4期514-519,共6页China Journal of General Surgery

摘　　要：背景与目的:随着经肛全直肠系膜切除(taTME)手术的推广,对直肠周围血管以及经肛入路的解剖标志进行不同角度的辨别与再认识显得十分必要,本研究旨在从经肛门视角对直肠中动脉(MRA)的发生和解剖位置进行分析,为taTME手术经肛操作部分进行理论指导。方法:收集2018年1月—2021年6月间上海交通大学医学院附属仁济医院术前MDT讨论后行taTME手术的临床病例资料,对患者的一般临床特征、MRA的发现率以及术中MRA出血情况进行分析。结果:将86例行taTME的患者纳入分析,taTME术中共发现MRA 61例(70.9%),其中双侧MRA 49例(57.0%),均行走于直肠侧韧带中。在对直肠侧韧带解剖分离过程中,在61例存在MRA的病例中共发生出血10例(16.4%),其中8例为双侧病例,2例为单侧病例。10例出血病例中,使用电钩操作8例,超声刀2例;9例通过电钩电凝或超声刀止血,仅1例选用Hemoloc止血。结论:MRA走行于直肠侧韧带中,经肛门视角对MRA发现更为精准。这一解剖学定位既可保证更好地根治肿瘤,也可对周围正常组织起到更好的保护作用。Background and Aims:With the promotion of transanal total mesorectal excision(taTME),it is essential to distinguish and re-understand the anatomical landmarks of perirectal vessels and the transanal approach from different angles.This study was performed to analyze the occurrence and anatomical position of the middle rectal artery(MRA)through the transanal perspective,so as to provide theoretical guidance for the transanal operation of taTME.Methods:Clinical data of patients who underwent taTME after preoperative MDT discussion in our hospital between January 2018 and June 2021 were collected.The general clinical characteristics of the patients,the detection rate of MRA,and the intraoperative MRA bleeding were analyzed.Results:A total of 86 patients who underwent taTME were included for analysis.MRA was found in 61 cases(70.9%)during taTME surgery,including bilateral MRA in 49 cases(57.0%),all of which ran in the lateral ligament of the rectum.During the dissection and separation of the lateral ligament of the rectum,bleeding occurred in 10 cases(16.4%)of the 61 patients with MRA,of whom,8 cases had bilateral MRA,and 2 cases had unilateral MRA.Among the 10 cases of bleeding,8 cases were operated by electric hook and 2 cases were operated by ultrasonic knife;bleeding were managed by electrocoagulation or ultrasonic knife in 9 cases,and Hemoloc was used for hemostasis in only 1 case.Conclusion:MRA runs in the lateral rectal ligament,and the finding of MRA is more precise through the transanal view.This anatomical location can not only ensure better radical treatment of the tumor but also provide better protection for surrounding normal tissues.

关 键 词：直肠肿瘤 全直肠系膜切除术 直肠中动脉 解剖标志 

分 类 号：R735.3[医药卫生—肿瘤]