结肠代食管术中结肠血管结构的研究

目的研究结肠血管构型和变异及其对替代食管的结肠段血供的影响。方法于582例结肠代食管术术中观察结肠血管的起源、走向、分支、构型、分布范围及血管搏动强弱,肝曲、脾曲区边缘血管的完整性,筛选出最佳移植结肠段供血管。结果左结肠动脉单支或共干起始于肠系膜下动脉者97．3％,缺如者仅0．7％;中结肠动脉单独起白肠系膜上动脉者占77．8％,存在副中结肠动脉者占6．2％,与右结肠动脉共干者7．8％,缺如8．2％;右结肠动脉单独起始于肠系膜上动脉者占39．7％,与中结肠动脉共干者23％,与回结肠动脉共干者28％,缺如者9．8％。脾曲区边缘血管弓完整者为96．8％,肝曲区边缘血管弓完整者88．7％。侧副边缘血管弓（Riolan弓）仅存在于7．6％的病例中。结论国人的结肠血管构型与国外尸解结果雷同,而在结肠边缘血管缺如比率、血管分支数和分布有所差异。左结肠动脉为最佳移植结肠段供血管,中结肠动脉次之。有上腹部手术史者需注意边缘血管弓和回流静脉的完整性。

Surgical anatomy of the colic vessels in Chinese and its influence on the operation of esophageal replacement with colon

Objective To investigate the configuration of colic vessels in Chinese and its influence on the operation of esophageal replacement with colon (ERC). Methods The origin, trend, branching, configuration, and distribution of the colic vessels, the intensity of the colic arterial impulse, the integrity of the marginal artery at the splenic flexure and hepatic flexure of colon were observed during the operation of ERC among 582 patients undergoing ERC, 402 males mad 180 females, aged 2~74, from 22 provinces, municipality, and autonomous regions. Results The left colic artery (LCA) stemmed from the inferior mesenteric artery (IMA) in 97.3% of the patients, with an absence rate of 0.7%. The middle colic artery (MCA) stemmed from the superior mesenteric artery (SMA) in 77.8% of the patients with an absence rate of 8.2%. Accessory middle colic artery (acMCA) , originating from the right colic artery, could be seen in 6.2% of the patients 39.7% of the right colic artery (RCA) stemmed from the SMA by itself, 23.0% of the RMA stemmed together with MCA, and 28.0% of the RCA stemmed together with the ileocolic artery. The absence rate of RCA was 9.8%. The intactness rate of marginal artery was 96.8% at the splenic flexure of colon, and was 88.7% at the hepatic flexure. The Rolan arch was seen in only 7.6% of the patients. Conclusion The configuration of colic vessels in Chinese was basically similar to those of the results of autopsies carried out abroad. The optimal supply artery of colic segment during ERC is LCA, followed by LCA. Attention should be paid to the integrity of marginal arteries and veins in the patients with history of epigastric operation.