左结肠动脉发自肠系膜上动脉变异一例

一般情况下,左结肠动脉单独或与乙状结肠动脉共干发自肠系膜下动脉.我们在解剖一具老年男性尸体时,未见肠系膜下动脉发出分支到降结肠.而在清理肠系膜上动脉的分支时,发现有一动脉在胰腺下缘处自肠系膜上动脉(直径7.86mm)发出.发出后,经腹膜壁层的后方横行向左,至降结肠附近分为升、降2支.升支与中结肠动脉的左支吻合,降支与和乙状结肠动脉的升支吻合.该动脉起始处外径3.18mm,全长14.30cm.     

左结肠动脉保留在腹腔镜下直肠癌根治术中的临床价值

目的 探讨腹腔镜下直肠癌根治术中保留左结肠动脉的临床价值。方法 回顾性分析我院行腹腔镜下直肠癌根治术的93例直肠癌患者的临床资料,将术中保留左结肠动脉的48例患者纳入保留组,术中未保留左结肠动脉的45例患者纳入未保留组。比较2组患者围术期相关指标、并发症发生情况及术后1、2、3年生存率。结果 与未保留组比较,保留组患者首次肛门排气时间、肠鸣音恢复时间及首次进食时间缩短,术中失血量减少,手术时间延长,差异均有统计学意义（P<0.05）;2组患者淋巴结清扫数比较差异无统计学意义（P>0.05）。2组术后并发症发生率及术后1、2、3年生存率比较,差异均无统计学意义（P>0.05）。结论腹腔镜下直肠癌根治术中保留左结肠动脉可减少术中出血量,促进患者术后胃肠功能恢复,且不会增加并发症,更符合人体解剖学结构理念。     

术中结肠灌洗在左半结肠癌性梗阻一期切除吻合中的应用

目的 探讨术中结肠灌洗在左半结肠癌性梗阻治疗中的应用价值。方法 回顾性分析84例左半结肠癌性梗阻病例的治疗方法及结果，其中41例行二期手术，11例行一期手术，32例行术中结肠灌洗一期切除吻合术，比较其吻合口瘘发生率、切口感染率、住院时间。结果 结肠灌洗组吻合口瘘发生率（3．13％），明显低于一期手术组（27．27％）（P〈0．05），和二期手术组（2．44％）无明显差别（P〉0．05）；各组间切口感染率差异无显著性意义（P〉0．05）；结肠灌洗组住院时间明显短于二期手术组（P〈0．05）。结论 术中结肠灌洗是一种安全的左半结肠梗阻一期手术方法，避免了分期手术与结肠造口，值得进一步研究与推广。     

急诊手术治疗梗阻性左半结肠癌的临床疗效观察

目的比较分析左半结肠全切除术与次全切除术治疗梗阻性左半结肠癌的临床疗效情况。方法临床收集梗阻性左半结肠癌患者86例,按照随机数字方法分成2组,每组43例。其中对照组患者均采用近端结肠全切、回肠一结直肠吻合的手术方式,研究组采用结肠次全切除术治疗,治疗后比较分析上述两组患者的相关临床资料。结果两组患者在手术时间、住院时间及术中出血量方面均具有统计学差异（P〈0．05）。同时,研究组在切口感染率、肺部感染率、吻合口漏发生率、住院期间死亡率方面明显低于对照组（P〈0．05）。结论左半结肠次全切除术的术式治疗梗阻性左半结肠癌患者是一种疗效显著、操作简单、并发症少、住院时间短、创伤较小的外科治疗方法,值得推广。     

肝总动脉合并胰动脉变异一例

笔者在解剖一成年女性尸体时发现,肝总动脉及其分支和胰动脉同时存在变异.为积累国人血管解剖学变异的数据,现报道如下. 该标本的肝总动脉发自肠系膜上动脉,行向右,除了分为肝固有动脉和胃十二指肠动脉外,在距起始处5.68 mm的左侧壁还发出中结肠动脉(外径2.14 mm),向左横行进入横结肠系膜,最终与右结肠动脉、回结肠动脉...     

腹腔镜下左半结肠切除术相关筋膜平面的解剖观察

目的：探讨左半结肠切除术相关筋膜的解剖学特点和外科平面的鉴别方法。临床资料和方法：2003-2004年南方医院普通外科施行的腹腔镜左半结肠切除术15例，病例均为左半结肠癌。对腹腔镜下左半结肠后外侧、中线侧和直肠后外侧相关筋膜的解剖特点和镜下定位标志进行观察和描述。结果：在乙状结肠第一曲外侧缘肠壁与左侧腰大肌筋膜之间存在一个固定的粘连带，它是左侧Toldt’s线的尾侧端点。左半结肠系膜后外侧存在肾前筋膜；中线侧存在主动脉前筋膜；直肠系膜后外侧存在盆筋膜壁层。这三个部位的筋膜相互延续。结论：乙状结肠和左侧腰大肌筋膜之间的粘连带是左半结肠切除术外侧分离的起点。肾前筋膜是衬贴于左半结肠和直肠系膜后面的一层连续筋膜，在不同的解剖位置有不同的表现形式。左半结肠切除术的外科平面统一于结直肠系膜与连续的肾前筋膜之间。     

左结肠动脉发自肠系膜上动脉一例

左结肠动脉作为一个单干起自肠系膜上动脉的变异罕见。中国解剖学会体质调查组1986年出版的《中国人体质调查》一书中所收集五篇文献共722例标本中,尚未报道过这种变异。我们在一例男性成年尸体解剖时发现一例,报道如下:自肠系膜上动脉距起始部3.1cm处,发出左结肠动脉,外径2.6mm,与肠系膜上动脉的角度为90°,有同名静脉伴行于腹膜壁层后方行向左下分为升、降二支,分别与中结肠动脉和乙状结肠动脉吻合构成边缘动脉,其长度为5.4cm,分叉点距降结肠水平距离为4.7cm,供应结肠左曲和降结肠的血液(附图)。了解左结肠动脉的这一解剖变异特点,对临床结肠外     

中结肠动脉变异一例

<正>一般情况下,中结肠动脉起自肠系膜上动脉,在胰下缘附近,偏右侧进入横结肠系膜,近结肠肝区时分为左右2支,分布于横结肠,并分别与左右结肠动脉吻合。而本例中结肠动脉过早分支,且存在起源于肠系膜上动脉的副中结肠动脉,比较少见,现报道如下。本例副中结肠动脉起自肠系膜上动脉的上壁,向横结肠左曲走行,发出时外径为1.52 mm,行经98.82 mm分为左右2支,外径分别为1.88 mm,1.52 m。中结肠动脉在副中结肠动脉下方     

不需吻接血管的空肠代食管的应用解剖学

在57具标本上,比较观察了上段小肠动脉、小肠动脉弓、左半结肠的动脉和边缘动脉的管径;在另94具标本上观察了上段小肠动脉弓的延续性。结果表明:可供移植空肠的动脉弓是完整的,空肠的血供与结肠相比无明显差异。为此,我们认为不需吻接血管的空肠代食管术是可行的。     

左半结肠梗阻一期肠切除吻合的治疗体会

目的探讨总结急性左半结肠梗阻一期肠切除吻合术的结果和治疗经验,为临床急性左半结肠梗阻一期肠切除吻合术提供参考依据。方法回顾性分析左半结肠梗阻行一期肠切除吻合术39例,其中直肠上段癌17例,乙状结肠癌7例,脾曲或近脾曲癌13例,乙状结肠扭转伴坏死2例。术前积极处理,有效的结肠灌法,一期病灶切除,行结肠端端吻合术。结果39例病例中有38例痊愈出院,均未发生吻合口瘘,术后2例切口皮下脂肪液化,3例出现肺部感染,1例术后2 d死于肺部感染,存活5年以上12例。结论要严格掌握适应证,正确手术操作,加强手术后护理,左半结肠急性梗阻行一期肠切除吻合术是安全可靠的。     

Anomalous origins of colic arteries

The topography of the celiac trunk and superior and inferior mesenteric arteries was studied by dissection in 27 embalmed cadavers. Variant vascular patterns were noted in four subjects. These consisted of: (1) an accessory right hepatic artery from the superior mesenteric artery, (2) an anomalous middle colic artery from the proximal segment of the splenic artery, and (3) two instances of an accessory left colic artery originating from the superior mesenteric artery. The precarious course of the middle colic artery (coming from the splenic artery) and its dominance in the formation of the marginal artery were thought to predispose the ascending and transverse colon to an increased risk of vascular damage. These cases also illustrate two variant patterns of formation of the marginal artery. In the case of the anomalous middle colic artery, the only contribution of the superior mesenteric artery to the marginal artery was through the anastomosis of its ileocolic branch with the right branch of the aberrant middle colic artery. In subjects with accessory left colic arteries, the superior mesenteric artery played a dominant role in the formation of the marginal artery by contributing the accessory left colic artery, which supplied the splenic flexure and the proximal part of the descending colon. These arterial variations underscore the importance of doing vascular studies prior to major abdominal surgery. © 1995 WiIey-Liss, Inc.     

Detailed anatomy of a left accessory aberrant colic artery

In an aged human female cadaver a left accessory aberrant colic artery (LAACA) was observed and studied. It originated from the superior mesenteric artery at 3 cm proximal to the middle colic artery, at the inferior border of pancreas, passing over Treitz’s muscle and continued covered by the superior duodenal fold where it crossed the inferior mesenteric vein. Further, it continued with a satellite vein anterior to the left renal vein and the anterior branch of the renal artery. The LAACA divided into an ascending branch and a descending one, anastomosed with the middle colic and proper left colic arteries; between its two primary branches and the splenic flexure of colon, a hypovascular area was observed. The surgical relevance of the LAACA detailed anatomy mainly relates to specific procedures performed in left colectomies and nephrectomies.     

A case of a right-sided sigmoid colon]

During dissecting practice by students at Chiba University in 1991, a rare anomaly was found in a cadaver of a 50-year-old Japanese male. The distal part of the colon, including the sigmoid colon, was excessively long and formed a loop behind the ascending colon. This anomalous colon consisted of four parts. The first part began in the left iliac fossa and passed across the lower posterior abdominal wall into the right iliac fossa; the second turned upward and ascended along the posterior surface of the ascending colon to the inferior surface of the right lobe of the liver; the third turned backward and descended to the right iliac fossa and was in contact with the posterior abdominal wall; the fourth curved medially and downward and ended in the rectum at the median line. Only the anterior surface of the anomalous colon was covered with the peritoneum, and its mesocolon was not found. The inferior mesenteric artery gave off four branches toward the distal three-fourths of the excessively long colon and the superior rectal artery to the upper part of the rectum. Since it did not directly give off any branches toward the descending colon and the first part of the anomalous colon (these portions were supplied by a marginal artery), the branch supplying the second part was considered to be equivalent to the left colic artery. Thus, the proximal half of the long colon (parts 1 and 2) can be regarded as a part of the descending colon, and the distal half as the sigmoid colon.(ABSTRACT TRUNCATED AT 250 WORDS)     

The third time is the charm--anastomosis between the celiac trunk and the left colic artery

An atypical case of abdominal vasculature, found in a 58-year-old woman is presented. The multidetector computed tomography angiogram revealed a large tortuous anastomotic vessel between the stem of the celiac trunk and the left colic artery, supplying branches for the left colon and pancreatic body and tail. We propose a simple embryological explanation for the development of this aberrant artery--the longitudinal ventral anastomosis, which connects the precursors of principal visceral arteries in a loop-like manner, loses its direct communication with the superior mesenteric artery but maintains its continuity above and below this level. This variation could pose a problem for radiological interpretation and affect surgical approaches to the aorta, left colon, and the pancreas.     

A case of celiacomesenteric trunk with some other arterial anomalies in a Japanese woman

We found a case of multiple arterial anomalies in a Japanese female cadaver during a routine dissection course. In the present case, a combination of three arterial anomalies was recognized in the abdominal digestive organs: (i) a celiacomesenteric trunk; (ii) a right accessory hepatic artery; and (iii) a left colic artery arising from a portion corresponding to the superior mesenteric artery. The typical celiacomesenteric trunk can be regarded as a variation of the arterial convergence at its origins progressing further between the celiac trunk and the superior mesenteric artery. The celiacomesenteric trunk in the present case included the left colic artery, which is usually one branch of the inferior mesenteric artery. Previously, a case had been reported in which all three arteries supplying the abdominal digestive organs had converged into one trunk, the celiac-bimesenteric trunk. Therefore, the celiacomesenteric trunk in the present case showed an intermediate degree of arterial convergence between that of the typical celiacomesenteric trunk and the celiac-bimesenteric trunk.     

The relationship of the inferior mesenteric vein with arteries

The investigation was based on the results of roentgen-anatomical study of 155 digestive tract complexes obtained from 155 cadavers of humans of both genders aged 17-90 years. It was established that in 91% (in 141 of 155) of the cases the trunk of the inferior mesenteric vein (IMV) was accompanied by the arteries only in the lower part (by inferior mesenteric artery) and in the middle part (by the left colic artery). The terminal part of IMV was separated from the artery. In 9% of (in 14 of 155) cases the trunk of the IMV is accompanied along the whole extent by different arteries (from down upwards): by inferior mesenteric artery and left colic artery from inferior mesenteric artery, and in its terminal part either by an additional anastomosis between the superior and inferior mesenteric arteries (in 5 of 14 cases), or by an additional anastomosis between superior and inferior mesenteric arteries and the branch or trunk of the proximal colic artery from the superior mesenteric artery (in 9 of 14 cases).     

A singular pancreatico-colic artery: anatomical report and clinical implications

After dissection of the abdominal cavity of a 59-year-old male, a long artery, extending from the hepatic artery to the transverse colon, and comprised proximally within the neck of the pancreas and distally within the transverse mesocolon, has been detected. This “pancreato-colic” artery (P-C A) was 13 cm in length and 4 mm in diameter at the origin. Its mesocolic part (2.5 mm in diameter) contributed to the formation of the marginal arcade. No middle colic artery from the superior mesenteric was observed. Thus, the transverse colon was supplied by the distal part of the P-C A. Considering both the P-C A caliber and topography, attention should be paid during pancreatic resections and in the interposition of the transverse colon for esophageal replacement in order to avoid serious bleeding and necrosis. Embryologically, the proximal part of the P-C A might be regarded as an intrapancreatic variant of the tract of the longitudinal anastomosis between the ventral segmental arteries, persisting in the adult as dorsal pancreatic artery. Different from its usual retropancreatic location, this part might be entrapped inside the gland by the developing primitive pancreatic anlages. The distal, mesocolic, part of the P-C A might be regarded as a replacing middle colic artery into the dorsal mesentery during midgut rotation.     

Fetal topohistology of the mesocolon transversum with special reference to fusion with other mesenteries and fasciae

The developing mesocolon transversum was investigated using hematoxylin and eosin‐stained semiserial sections derived from 17 human fetuses between 12 and 30 weeks of gestation. The mesocolon was attached to the mesoduodenum and greater omentum until 12 weeks. However, the fetal duodenal attachment appeared not to correspond to the right colic flexure in adults. The greater omentum and mesocolon were likely to be irregularly folded at the attachment site possibly because the developing transverse colon “ran into” and pushed up the greater omentum and pancreatic head. Lymphatic vessels invaded the indistinct fusion plane to destroy the primary configuration. Moreover, the mesocolon seemed to “seize” or take‐over some parts of the splenic side of the greater omentum, but the thick gastric side containing the right gastroepiploic artery and vein remained along the greater curvature. Until 20 weeks, the left colic flexure was fixed to the pancreatic tail, and near the flexure the mesocolon also fused with the renal fascia. The left splenic end of the greater omentum was folded and fused together to form a thick ligament‐like structure, i.e., the gastrocolic ligament. In addition, near the duodenojejunal junction, a peritoneal bridge was often seen containing the inferior mesenteric artery or vein. Although surgeons generally believe that the mesocolon can be gently detached from the greater omentum, the fusion plane in adults appears to be the result of secondary modification and simplification by vascular development. Clin. Anat. 22:716–729, 2009. © 2009 Wiley‐Liss, Inc.     

A middle mesenteric artery

In 114 cases of the transverse colon isolated from cadavers (50 male, 64 female), anatomical examinations of the arterial system of the colon were performed. Arteriograms were obtained after dissecting and contrasting the colonic vessels with Mixobar contrast. In one case, on arteriography of the colon with its mesentery isolated from a 55-year-old male cadaver, a rare anatomical variant was found. The third mesenteric artery originated directly from the aorta—halfway between the superior and inferior mesenteric arteries and ascended obliquely in the direction of the hepatic flexure of the colon. Supply area of the artery was typical for the middle colic branch of the superior mesenteric artery: the distal segment of the ascending colon and the transverse colon. Such a variation, although very rare, may have particular impact on diagnosis and even the method and range of surgery.