Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China.
World J Gastroenterol. 2018 Aug 28;24(32):3671-3676. doi: 10.3748/wjg.v24.i32.3671.
To investigate the vascular anatomy of inferior mesenteric artery (IMA) in laparoscopic radical resection with the preservation of left colic artery (LCA) for rectal cancer.
A total of 110 patients with rectal cancer who underwent laparoscopic surgical resection with preservation of the LCA were retrospectively reviewed. A 3D vascular reconstruction was performed before each surgical procedure to assess the branches of the IMA. During surgery, the relationship among the IMA, LCA, sigmoid artery (SA) and superior rectal artery (SRA) was evaluated, and the length from the origin of the IMA to the point of branching into the LCA or common trunk of LCA and SA was measured. The relationship between inferior mesenteric vein (IMV) and LCA was also evaluated.
Three vascular types were identified in this study. In type A, LCA arose independently from IMA (46.4%, = 51); in type B, LCA and SA branched from a common trunk of the IMA (23.6%, = 26); and in type C, LCA, SA, and SRA branched at the same location (30.0%, = 33). The difference in the length from the origin of IMA to LCA was not statistically significant among the three types. LCA was located under the IMV in 61 cases and above the IMV in 49 cases.
The vascular anatomy of the IMA and IMV is essential for laparoscopic radical resection with preservation of the LCA for rectal cancer. To recognize different branches of the IMA is necessary for the resection of lymph nodes and dissection of vessels.
探讨保留左结肠动脉（LCA）的直肠癌腹腔镜根治术中肠系膜下动脉（IMA）的血管解剖结构。
回顾性分析 110 例接受腹腔镜保 LCA 直肠癌根治术的患者，术前对每位患者进行 3D 血管重建，评估 IMA 的分支。术中评估 IMA、LCA、乙状结肠动脉（SA）和直肠上动脉（SRA）之间的关系，测量 IMA 起始处至 LCA 分支处或 LCA 和 SA 共干的长度。评估肠系膜下静脉（IMV）与 LCA 的关系。
本研究发现 3 种血管类型。在 A 型中，LCA 独立于 IMA 起源（46.4%，n=51）；在 B 型中，LCA 和 SA 从 IMA 的共同干分支（23.6%，n=26）；在 C 型中，LCA、SA 和 SRA 在同一部位分支（30.0%，n=33）。三种类型中，IMA 起始处至 LCA 的长度差异无统计学意义。61 例 LCA 位于 IMV 下方，49 例位于 IMV 上方。
IMA 和 IMV 的血管解剖结构对于保留 LCA 的直肠癌腹腔镜根治术至关重要。认识 IMA 的不同分支对于淋巴结清扫和血管解剖至关重要。
