Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain.
Cardiovascular Surgery Department, Hospital Clinico Universitario, Valencia, Spain.
Tech Coloproctol. 2017 Jul;21(7):567-572. doi: 10.1007/s10151-017-1663-3. Epub 2017 Jul 27.
The medial approach in laparoscopic splenic flexure mobilization is based on the entrance to the lesser sac just above the ventral edge of the pancreas (VEOP). The artery of Moskowitz runs through the base of the mesocolon, just above the VEOP. The aim of this study was to assess the incidence of the artery of Moskowitz, its route and its distance from the VEOP.
We performed a cadaveric study on 27 human cadavers. The vascular arcades of the splenic flexure were dissected, the number of vascular arches, and the origin and localization of its terminal anastomosis were recorded. The splenic flexure avascular space (SFAS) was defined as the avascular zone in the mesocolon delimited by the VEOP, middle colic artery, ascending branch of the left colic artery and the vascular arch of the splenic flexure nearest to the VEOP and was quantified as the distance between the VEOP and the most proximal arch RESULTS: The artery of Drummond was identified in 100% of the cadavers. In 5 of 27 (18%) Riolan's arch was present, and in 3 of 27 (11%) the Moskowitz artery was found. The mean distance from the VEOP to the artery of Moskowitz was 0.3 cm (SD 0.04). This vascular arch travelled from the origin of the middle colic artery to the distal third of the ascending branch of the left colic artery. The SFAS was greater (p = 0.001) in cadavers that only presented the artery of Drummond (mean 6.8 cm; SD 1.25) than in those with Riolan's arch (mean 4.5 cm; SD 0.5) CONCLUSIONS: In the medial approach for laparoscopic mobilization of the splenic flexure, when only one of the arches is present, the avascular area is an extensive and secure territory. If the artery of Moskowitz is present, the area is nonexistent and this would contraindicate the approach due to risk of iatrogenic bleeding. A radiological preoperatory study could be essential for accurate and safe surgery in this area.
腹腔镜脾曲游离的内侧入路基于胰腺腹侧缘（VEOP）上方小网膜的入口。Moskowitz 动脉穿过横结肠系膜的基底，就在 VEOP 上方。本研究旨在评估 Moskowitz 动脉的发生率、其走行及其与 VEOP 的距离。
我们对 27 具人体尸体进行了尸体研究。解剖脾曲的血管弓，记录血管弓的数量及其终末吻合的起源和定位。脾曲无血管区（SFAS）定义为 VEOP、结肠中动脉、左结肠升支和最靠近 VEOP 的脾曲血管弓之间的无血管区，并将其量化为 VEOP 和最靠近 VEOP 的弓之间的距离。
在 100%的尸体中识别出了 Drummond 动脉。在 27 具尸体中，有 5 具（18%）存在 Riolan 弓，3 具（11%）存在 Moskowitz 动脉。VEOP 与 Moskowitz 动脉的平均距离为 0.3cm（SD 0.04）。这条血管弓从结肠中动脉的起源处延伸到左结肠升支的远端三分之一。仅存在 Drummond 动脉的尸体的 SFAS 更大（p=0.001）（平均 6.8cm；SD 1.25），而存在 Riolan 弓的尸体的 SFAS 较小（平均 4.5cm；SD 0.5）。
在腹腔镜脾曲游离的内侧入路中，如果只有一个弓存在，无血管区是一个广泛而安全的区域。如果存在 Moskowitz 动脉，则该区域不存在，由于存在医源性出血的风险，该入路将被禁止。术前影像学研究对于该区域的准确和安全手术至关重要。
