背景:由于前肠和中肠的复杂融合以及横结肠血管的变化,腹腔镜和机器人手术很难进行。尽管已经对右半结肠的血管进行了调查,结肠中动脉(MCA)的变化以及与跨结肠周围血管的关系尚不清楚。我们使用计算机断层扫描血管造影(CTA)和尸体标本研究了MCA的变化,以及使用CTA研究了肠系膜上静脉(SMV)与MCA之间的关系。横结肠周围血管的分类可能导致更安全可靠的手术。
方法:该研究包括2014年至2020年在我们机构接受CTA的505例连续患者和44具尸体标本。使用CT图像分析血管解剖分类和关系。
结果:MCA定义为由肠系膜上动脉(SMA)产生的动脉,该动脉在远端流入横结肠。分类如下:I型,从普通树干向右和向左分支;II型,右支和左支与SMA分开分叉;和III型,MCA从SMA以外的血管分支出来。II型被分为两个亚型,IIa型有一个左分支,IIb型有两个或更多来自SMA的左分支。在CTA和尸体研究中,分别,分类如下:I型,n=290和n=31;IIa型,n=211和n=13;IIb型,n=3和n=0;和III型,n=1和n=0。我们将MCA和SMV左侧之间的关系分为三种类型:A型,普通树干沿着SMV的左边缘延伸(n=173;59.7%);B型,MCA的右分支沿SMV的左边缘延伸(n=116;40.0%);和类型C,MCA在SMV的背侧运行(n=1;0.3%)。
结论:本研究揭示了MCA分支分类以及SMV与MCA之间的关系。术前CT血管造影可能能够可靠地识别血管变异,这在临床实践中可能是有用的。
BACKGROUND: Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon are unknown. We investigated variation of the MCA using computed tomography angiography (CTA) and cadaver specimen and the relationship between the superior mesenteric vein (SMV) and MCA using CTA. The classification of vessels around the transverse colon may lead to safer and reliable surgery.
METHODS: This study included 505 consecutive patients who underwent CTA in our institution from 2014 to 2020 and 44 cadaver specimens. Vascular anatomical classifications and relationships were analyzed using CT images.
RESULTS: The MCA was defined as the arteries arising from the superior mesenteric artery (SMA) that flowed into the transverse colon at the distal ends. The classifications were as follows: type I, branching right and left from common trunk; type II, the right and left branches bifurcated separately from the SMA; and type III, the MCA branched from a vessel other than the SMA. Type II was subclassified into two subtypes, type IIa with one left branch and type IIb with two or more left branches from SMA. In the CTA and cadaver studies, respectively, the classifications were as follows: type I, n = 290 and n = 31; type IIa, n = 211 and n = 13; type IIb, n = 3 and n = 0; and type III, n = 1 and n = 0. We classified the relationship between the MCA and left side of the SMV into three types: type A, a common trunk runs along the left edge of the SMV (n = 173; 59.7%); type B, a right branch of the MCA runs along the left edge of the SMV (n = 116; 40.0%); and type C, the MCA runs dorsal of the SMV (n = 1; 0.3%).
CONCLUSIONS: This study revealed that The MCA branching classifications and relationship between the SMV and MCA. Preoperative CT angiography may be able to reliably identify vessel variation, which may be useful in clinical practice.