经血管造影评估老年患者左侧结直肠灌注特性。

Evaluation of characteristics of left-sided colorectal perfusion in elderly patients by angiography.

机构信息

Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.

出版信息

World J Gastroenterol. 2020 Jun 28;26(24):3484-3494. doi: 10.3748/wjg.v26.i24.3484.

BACKGROUND

Handling of the inferior mesenteric artery (IMA) and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal cancer. However, the branching of this artery and the drainage patterns of this vein vary among individuals, and the characteristics and perfusion region of this artery in elderly patients remain unclear.

AIM

To evaluate the characteristics and perfusion region of the IMA in elderly patients using angiography.

METHODS

We enrolled 154 patients (> 65 years old) who underwent digital subtraction angiography of the IMA. The characteristics, bifurcation, and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum were examined using digital subtraction angiography. Collateral arterial arches and the IMA hemoperfusion region were also recorded. Perfusion regions were cross-referenced with clinical and anatomical features by the univariate analysis.

RESULTS

Of 154 patients, 25 (16.2%) had IMA lesions. The left colic artery arose independently from the IMA in 44.2% of patients, shared a trunk with the sigmoid artery in 35.1%, shared an opening with the sigmoid and superior rectal arteries in 16.9%, and was absent in 5.1%. The IMA perfusion region stopped at the splenic flexure in 50 (32.5%) patients. The collateral circulation existed in the colonic perfusion region, including the marginal artery (Drummond's artery), the ascending branch of the left colonic artery to supply the transverse colon, and the arc of Riolan with a frequency of 100%, 22.7%, and 1.9%, respectively. The IMA perfusion region was independently associated with the comorbidity of atherosclerosis, IMA atherosclerotic lesion, branching pattern, collateral circulation, and marginal artery integrity.

CONCLUSION

The IMA and its branches are prone to arteriosclerosis, and IMA perfusion may be interrupted at the splenic flexure in elderly patients. The applicability and precision of preoperative angiography for evaluating the IMA branching and perfusion patterns could facilitate geriatric laparoscopic left-sided colorectal cancer surgery with suspicion of poor IMA perfusion.

背景

在根治性左半结直肠癌切除术中，处理肠系膜下动脉（IMA）并保持吻合口灌注非常重要。然而，该动脉的分支和该静脉的引流模式在个体之间存在差异，并且老年人的该动脉的特征和灌注区域尚不清楚。

目的

通过血管造影评估老年患者的 IMA 特征和灌注区域。

方法

我们纳入了 154 例（> 65 岁）接受 IMA 数字减影血管造影的患者。使用数字减影血管造影检查 IMA 的特征、分支、分布以及左结肠和直肠的吻合灌注终点。还记录了侧支动脉弓和 IMA 血液灌注区域。通过单变量分析将灌注区域与临床和解剖特征进行交叉引用。

结果

在 154 例患者中，有 25 例（16.2%）存在 IMA 病变。左结肠动脉在 44.2%的患者中独立于 IMA 起源，在 35.1%的患者中与乙状结肠动脉共享主干，在 16.9%的患者中与乙状结肠和直肠上动脉共享开口，而在 5.1%的患者中不存在。IMA 灌注区域在脾曲处停止，50 例（32.5%）患者。在结肠灌注区域存在侧支循环，包括边缘动脉（Drummond 动脉）、左结肠动脉的升支供应横结肠、以及 Riolan 弓，频率分别为 100%、22.7%和 1.9%。IMA 灌注区域与动脉粥样硬化合并症、IMA 动脉粥样硬化病变、分支模式、侧支循环和边缘动脉完整性独立相关。