Fernando E D P S, Deen K I
Department of Anatomy, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Clin Anat. 2009 Sep;22(6):712-5. doi: 10.1002/ca.20838.
The ileocecal valve (ICV) is known to control the flow of chyme and to prevent bacterial colonization of the small intestine. Preservation of this segment during right hemicolectomy is likely to prevent loss of its function. This study aimed at evaluating the arterial supply of the ICV to help preserve the valve during right hemicolectomy. Fifty-four fresh human cadavers (37 male, 17 female; median age: 54 years, range: 18-90 years) were studied after relatives gave written, informed consent. At postmortem, 20 cm of terminal ileum with the ileocecal segment and up to 20 cm of ascending colon were removed en bloc with its mesentery and blood supply. The ileocolic artery was cannulated and injected with 10 ml of water-soluble red dye under pressure. The arterial supply was dissected to demonstrate a pattern. In all, the ICV was supplied by the ileocolic artery, a branch of the superior mesenteric, which divided into an anterior and a posterior cecal artery. A marginal branch of the right colic was noted to contribute to ICV blood supply in only two (4%). Furthermore, study of the anastomosis at the ICV showed that the anterior cecal artery was present in all (100%), posterior cecal in 48 (89%), and recurrent ileal artery in 53 (98%). A rich anastomosis between vessels at the ICV; small "windows," short tributaries, were seen in 38 (70%), whereas a poor anastomotic network at the ICV; large "windows," long tributaries, between these vessels were seen in 12 (22%). In four (8%), we were unable to clearly determine between rich and poor anastomotic networks. Other variants included, absent posterior cecal artery in six (11%) and absent recurrent ileal artery in one (2%). The ICV has a predictable blood supply in the majority of patients. Preservation of the anterior cecal artery would ensure a vascularized ICV in right hemicolectomy.
已知回盲瓣（ICV）可控制食糜流动并防止细菌在小肠定植。在右半结肠切除术中保留该节段可能会防止其功能丧失。本研究旨在评估回盲瓣的动脉血供，以帮助在右半结肠切除术中保留该瓣膜。在亲属签署书面知情同意书后，对54具新鲜人体尸体（37例男性，17例女性；年龄中位数：54岁，范围：18 - 90岁）进行了研究。尸检时，将带有回盲段的20 cm末段回肠以及长达20 cm的升结肠及其系膜和血供整块切除。将回结肠动脉插管并在压力下注入10 ml水溶性红色染料。解剖动脉血供以显示其模式。总体而言，回盲瓣由肠系膜上动脉的分支回结肠动脉供血，该动脉分为盲肠前动脉和盲肠后动脉。仅在两例（4%）中发现右结肠的边缘支对回盲瓣血供有贡献。此外，对回盲瓣处吻合情况的研究表明，盲肠前动脉在所有病例中均存在（100%），盲肠后动脉在48例（89%）中存在，回肠返动脉在53例（98%）中存在。在回盲瓣处血管之间存在丰富的吻合；在38例（70%）中可见小的“窗口”、短的分支，而在12例（22%）中可见回盲瓣处吻合网络较差；血管之间有大的“窗口”、长的分支。在4例（8%）中，我们无法明确区分丰富和较差的吻合网络。其他变异包括6例（11%）中盲肠后动脉缺如，1例（2%）中回肠返动脉缺如。大多数患者的回盲瓣有可预测的血供。在右半结肠切除术中保留盲肠前动脉将确保回盲瓣有血供。
