肠系膜下动脉解剖学研究进展  

Advances in the anatomy study of the mesenteric artery

作　　者：赵博天 丁源一[1] 牛文博 胡旭华[1] 于滨[1] ZHAO Botian;DING Yuanyi;NIU Wenbo;HU Xuhua;YU Bin(The Second Department of Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Graduate School,Hebei Medical University,Shijiazhuang 050017,China)

机构地区：[1]河北医科大学第四医院外二科,河北石家庄050011 [2]河北医科大学研究生院,河北石家庄050017

出　　处：《中国普通外科杂志》2023年第4期604-614,共11页China Journal of General Surgery

摘　　要：近年来,结直肠癌的发病率不断上升,腹腔镜下的结直肠癌根治手术正被越来越多地应用于临床上。在腹腔镜下左侧结直肠癌根治手术中,肠系膜下动脉(IMA)是最重要的解剖标志之一,其处理也是手术过程中重要步骤,对手术质量、患者术后恢复及患者预后有影响。术中不恰当的处理IMA会造成术中血管损伤,出血会污染手术视野,延长手术时间,血管的不恰当结扎有可能会导致手术部位结肠缺血,进而增加吻合口瘘等并发症发生的风险。因此,在左侧结直肠癌手术中,对血管解剖的准确理解是一台成功的肿瘤根治手术的基础。IMA的解剖结构变化很大,通过各种方式如解剖学、血管造影或者外科研究所得到的解剖结构不尽相同,又因人种甚至地域不同存在解剖差异,有必要进行总结归类。虽然IMA的起源变异较小,但在分支类型、分支的数量和某些分支的存在与否方面在不同个体之间是存在较大差异的,不同学者的研究结果也不尽相同。在IMA的解剖分型上,虽然没有一个统一的分类系统,但相似之处都包括3个主要的分支类型,即左结肠-乙状结肠共干、直肠-乙状结肠共干以及三支血管同时从IMA上发出的类型。从结直肠肿瘤疾病手术治疗角度考虑,对术前通过影像检查及手术过程中记录的IMA及其分支的解剖结构数据进行分析具有重要意义。因此,本文归纳既往文献报道的解剖类型及不同分支之间的相对关系,对IMA的正常和变异的解剖结构进行描述,包括相关胚胎学的简要概述,并引入一种新的分型系统来评估概括IMA的解剖结构,为外科医生在术前和术中评估肠系膜下血管系统,提高手术总体质量,达到充分合理肿瘤根治范围,优化手术治疗提供理论参考和指导。In recent years,the incidence of colorectal cancer has been continuously increasing,and laparoscopic radical surgery for colorectal cancer is being increasingly applied in clinical practice.In laparoscopic radical surgery for left-sided colon and rectal cancer,the inferior mesenteric artery(IMA)is one of the most important anatomical landmarks,and its handling is also an important step in the surgical process,which can affect the surgical quality,postoperative recovery,and patient prognosis.Inappropriate handling of the IMA during surgery can cause vascular injury,bleeding that can contaminate the surgical field,prolong the operative time,and improper ligation of blood vessels can lead to colon ischemia at the surgical site,thereby increasing the risk of complications such as anastomotic leakage.Therefore,accurate understanding of vascular anatomy is the basis of successful tumor radical surgery in left-sided colon and rectal tumor surgery.The anatomy of the IMA varies greatly,and different results are obtained through various methods such as anatomy,angiography,or surgical research,and there are differences in anatomy due to different races and even regions.It is necessary to summarize and classify them.Although the origin of the IMA varies slightly,there are significant differences in types of branches,number of branches,and the presence or absence of certain branches among different individuals.The results of different researchers are also not exactly the same.Although there is no unified classification system for the anatomical classification of the IMA,the similarities include three major types of branches,including the left colo-sigmoid trunk,the recto-sigmoid trunk or common trifurcation.From the perspective of surgical treatment of colorectal cancer,it is of great significance to analyze the anatomical structure data of the IMA and its branches recorded during preoperative imaging examination and surgery.Therefore,this article summarizes the reported anatomical types and relative relationships between dif

关 键 词：结直肠外科手术 肠系膜下动脉 解剖变异 综述 

分 类 号：R656.9[医药卫生—外科学]