■肠系膜上动脉(SMA)和肠系膜下动脉(IMA)之间的侧支通路在结肠手术中起重要作用。最著名的是Drummond边缘动脉和Riolan弓。莫斯科维茨动脉,也被称为蜿蜒的肠系膜动脉,是一种鲜为人知的附带途径,代表了SMA和IMA之间的另一种联系。Moskowitz动脉沿结肠肠系膜底延伸,代表中结肠动脉近端段和左结肠动脉上行支之间的联系。
■通过使用计算机断层扫描(CT)研究,在术前患者中了解Moskowitz动脉(弯曲肠系膜动脉)的存在和重要性。
我们回顾性回顾了2015年4月至2018年9月在Yeditepe大学医院放射科使用静脉造影检查的所有腹部CT图像。18岁以上静脉造影患者(动脉和静脉相,横截面厚度为0.625mm),做了腹部CT扫描,无任何腹部手术的患者被纳入研究.作为筛选的结果,109个符合合格标准的CT扫描被纳入本研究。
■本研究共109例,其中男性50例(45.9%),女性59例(54.1%)。在18例(16.5%)中发现了Moskowitz动脉;男性8例,女性10例。Riolan足弓出现在30例病例中,其中15人是男性,15人是女性。在我们的研究中,Moskowitz动脉和Riolan弓作为独立的血管结构被监测,在所有有莫斯科维茨动脉的病例中,Riolan的拱门也在场。联合MCA新兴型与MA的存在有统计学意义(p<0.05),合并分支12例,单支6例。LCA类型与MA的存在之间存在统计学上的显著差异(p<0.05),Moskowitz动脉最常见于1型LCA。
■了解Riolan\'s弓与Moskowitz动脉之间的关系是有价值的,在Riolan弓存在的情况下,术前评估该动脉可能是有益的。此外,术前放射学评估及其重要性在通过内侧腹腔镜入路脾弯曲动员期间最大限度地减少术中出血和降低结直肠吻合口漏的风险方面是突出的。
BACKGROUND: The collateral pathways between the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) play an important role in colonic surgery. The most well-known are the Drummond marginal artery and Riolan\'s arch. The Moskowitz artery, also known as the meandering mesenteric artery, is a lesser-known collateral pathway and represents another link between SMA and IMA. The Moskowitz artery runs along the colonic mesentery floor and represents the link between the proximal segment of the middle colic artery and the ascending branch of the left colic artery.
OBJECTIVE: To comprehend the presence and importance of the Moskowitz artery (meandering mesenteric artery) in preoperative patients by using computed tomography (CT) studies.
METHODS: We retrospectively reviewed all abdominal CT images performed using intravenous contrast for any reason at the Radiology Department of Yeditepe University Hospital between April 2015 and September 2018. Patients older than 18 years with intravenous contrast (arterial and venous phases with a cross-section thickness of 0.625 mm), who underwent abdominal CT scan, and patients without any abdominal surgery were included in the study. As a result of the screening, 109 CT scans with eligibility criteria were included in this study.
RESULTS: There were 109 cases in this study; 50 (45.9%) of them were male and 59 (54.1%) were female. Moskowitz artery was found in 18 (16.5%) cases; 8 were males and 10 were females. Riolan\'s arch was present in 30 cases, of whom 15 were male and 15 were female. In our study Moskowitz artery and Riolan\'s arch were monitored as separate vascular structures, and in all cases with Moskowitz artery, Riolan\'s arch was also present. There was a statistically significant difference (p < 0.05) between the combined MCA emerging type and the presence of MA, and 12 cases with combined branch and 6 cases with single branch had Moskowitz artery. There was a statistically significant difference (p < 0.05) between LCA types and the presence of MA, and the Moskowitz artery was the most common seen at type 1 LCA.
CONCLUSIONS: Knowledge of the relationship between Riolan\'s arch and the Moskowitz artery is valuable, and preoperative evaluation of this artery may be beneficial in the presence of Riolan\'s arch. In addition, preoperative radiological evaluation and its importance are prominent in minimising intraoperative bleeding during splenic flexure mobilisation with a medial laparoscopic approach and reducing the risk of colorectal anastomosis leakage.