肠系膜下动脉解剖分型在肠系膜下动脉结扎方式选择中的应用

目的探讨肠系膜下动脉（IMA）各种解剖分型及血管长度差异的相关因素,为结直肠癌低位结扎IMA提供参考。 方法前瞻性收集温州医科大学附属第一医院2019年7月至2020年4月因乙状结肠癌及直肠癌接受根治性手术治疗的患者的病例资料,术前使用增强CT对IMA进行重建,对IMA分型进行统计分析。并选取温州医科大学解剖教研室10具成人尸体,进行IMA解剖。 结果共纳入172例血管充盈可,重建效果佳的患者数据,纳入统计。按照Murono分型标准,其中Ⅰ型88例,Ⅱ型66例,Ⅲ型16例,Ⅳ型患者2例（不纳入后续统计分析）。170例患者中,IMA主干长（42.96±6.78）mm,体重是IMA主干长的主要影响因素（系数=0.253,P＜0.05）,IMA主干长度=23.12+0.253×体重（R²=0.181）。体重每增加一个单位（kg）,长度平均增加0.253个单位（mm）。 结论对IMA术前行增强CT可以了解IMA分型,有助于低位结扎位置的选择。可通过体重对IMA血管长度进行预估,从而选择最合适的血管处理方式。

The application of inferior mesenteric artery anatomical classification in the selection of inferior mesenteric artery ligation

ObjectiveTo explore various anatomical types and vascular length related factors of inferior mesenteric artery (IMA), and to provide a reference for lower ligation of IMA for colorectal cancer. MethodsThe patients who received surgery for colorectal cancer in the First Affiliated Hospital of Wenzhou Medical University from July 2019 to April 2020 were retrospectively analyzed. IMA imaging of inferior mesenteric artery was performed with enhanced CT before operation, and the IMA classification was statistically summarized. In addition, ten adult cadavers from Wenzhou Medical University were dissected by IMA. ResultsThere were 172 patients with good filling and good reconstruction effect. According to Murono classification criteria, eighty-eight cases were type Ⅰ, sixty-six cases were type Ⅱ, and 16 cases were type Ⅲ. There were 2 type Ⅳ patients (not included in the statistics). The length of IMA trunk was (42.96±6.78)mm, and there was a certain degree of linear relationship between body weight and IMA trunk length, so body weight was the main influencing factor (coefficient=0.253, P＜0.05). The final equation is IMA trunk length=23.12+0.253×body weight (R²=0.181). The regression equation showed that body weight was positively correlated with IMA dry length, and the average length increased by 0.253 units (mm) for each unit (kg) increase of body weight. ConclusionEnhanced CT for IMA can clarify the classification of IMA and the specific vascular conditions, which is helpful to select the location of low ligation. The length of blood vessels can be estimated by BMI, so as to provide the most appropriate way of vascular treatment.