Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
Colorectal Dis. 2018 Nov;20(11):1041-1046. doi: 10.1111/codi.14287. Epub 2018 Jun 19.
Surgery for colorectal cancer located in the splenic flexure is difficult to perform because of the complex anatomy. Recently, in addition to the middle colic artery and left colic artery (LCA), the accessory middle colic artery (AMCA) has been recognized as a feeding artery for the left-sided colon. This study aimed to evaluate the vascular anatomy of the splenic flexure focusing on the AMCA in a large number of patients.
A total of 734 patients who underwent CT before surgery for colorectal cancer were enrolled. We retrospectively evaluated the vascular anatomy using both two- and three-dimensional CT angiography.
The AMCA existed in 36.4% of the cases (n = 267). In many cases, it originated from the superior mesenteric artery (n = 228, 85.4%). The AMCA had a common trunk with the transverse pancreatic artery in 54 patients (20.2%). The frequency of the presence of the AMCA was associated with the branching pattern of the LCA, and was more frequent when the LCA was absent (P < 0.001).
The presence of the AMCA is not rare and the AMCA has some branching patterns; therefore, recognizing it preoperatively and intra-operatively is important, being especially careful when the LCA is absent.
由于脾曲解剖结构复杂，因此对于位于脾曲的结直肠癌的手术操作较为困难。最近，除了中结肠动脉和左结肠动脉（LCA）外，副中结肠动脉（AMCA）也被认为是左半结肠的供血动脉。本研究旨在评估脾曲的血管解剖结构，重点关注 AMCA 在大量患者中的表现。
共纳入 734 例在术前因结直肠癌接受 CT 检查的患者。我们使用二维和三维 CT 血管造影术对血管解剖结构进行回顾性评估。
36.4%的病例（n=267）存在 AMCA。在许多情况下，它起源于肠系膜上动脉（n=228，85.4%）。54 例患者的 AMCA 与胰横动脉具有共同的主干（20.2%）。AMCA 的存在频率与 LCA 的分支模式有关，当 LCA 不存在时，其更常见（P<0.001）。
AMCA 的存在并不罕见，并且具有多种分支模式；因此，术前和术中识别它很重要，特别是在 LCA 缺失时需要特别小心。
