腹腔镜下肠系膜下血管的临床解剖学

目的:探讨腹腔镜直肠癌根治术中肠系膜下血管的局部解剖学特征及定位标志。方法:对接受腹腔镜直肠癌根治术的105例直肠癌患者进行活体解剖学观察。结果:切开中线侧Toldt’s线,在主动脉分权头侧的Toldt’s间隙内可顺利定位肠系膜下动脉(inferior mesenteric artery,IMA)起点。牵引乙状结肠系膜使IMA与主动脉保持垂直状态,可形成系膜后操作窗,顺利暴露IMA根部。肠系膜下静脉(inferior mesenteric vein, IMV)在乙状结肠结肠系膜后位可清晰暴露和游离,结合系膜前位游离,可高位离断。结论:Toldt’s间隙是定位IMA的正确外科平面,主动脉分权可作为定位标志。结肠系膜后位和前位解剖法相结合,是识别和定位IMV的有效手段。

Inferior mesenteric vessels related clinical anatomy in laparoscopy

Objective: To explore the anatomical characteristics of the inferior mesenteric vessels in laparoscopic radical resection of rectal cancer. Methods: Live anatomical observations were carried out on 105 rectal cancer patients undergoing laparoscopic radical resection in Nanfang Hospital from Nov, 2002 to June, 2005. Results: The origin of inferior mesenteric artery (IMA) was successfully localized by dissection in Toldt's space cephalad to the aortic branch after the middle Toldt's line incision. It was unveiled in the operation window posterior to mesosigmoid formed by pulling the mesentery and keeping vertical angle to the aorta. The inferior mesenteric vein (IMV) was exposed and dissected clearly posterior to the mesosigmoid. Combined with anterior dissection, high level division of IMV was achieved. Conclusion: The Toldt's space is the right surgical plane to localize the IMA; the aortic bifurcation is the location landmark. Vertical traction, artery skeletonization and division at origin are the foundation of anatomy. Dissections both posterior and anterior to the mesosigmoid are effective methods to identify and divide the IMV at high level.