以第3支小肠动脉为蒂的游离空肠移植的应用解剖研究

The blood supply of third intestinal artery to the free jejunal transplantation:an applied anatomical study

目的以第3支小肠动脉为蒂灌注观察,了解其有效供血的空肠范围,为移植手术提供解剖依据。方法对32例固定小肠、21例新鲜小肠标本解剖测量及醋酸乙酯、ABS血管灌注观察。结果两组标本血管变异在可接受范围内。在第1～5小肠动脉中,以第3支小肠动脉管径较粗。以第3支小肠动脉血供分布区域,肠壁、系膜血管吻合交通丰富,血液循环较好。灌注后均匀红染的空肠游离缘长度为(142．2±62．3)(69．0～206．6)cm；ABS有效分布的动脉弓长度为(30．8±7．3)(23．0～37．3)cm。结论以第3支小肠动脉为蒂作游离空肠移植,有足够长度的有效血管弓及足够长度血供的肠管,可满足临床作食管重建的需要。

Objective To assess the effective length of jejunal graft when the 3^rd intestinal artery is utilized as vascular pedicle and afford a reliable theoretic base for clinical esophageal reconstruction. Methods In 32 formalin preserved and 21 fresh cadaver specimens, the diameter of 1st to 5th intestinal arteries and diameter of arterial arches are measured with linear calibre. Measure the length of jejunum that can be harvested as graft when the arches are extended. In the 21 fresh specimens, the 1st, 2nd, 4th and 5th intestinal arteries are ligated, acetic ester stained with red dye were injected into the lumen of 3rd intestinal artery via catheter. Extent of distribution of the arteries to the jejunum was observed. And then red ABS solution was injected into the 3rd intestinal artery to make into cast specimen. The blood supply distribution of jejunum through 3rd intestinal artery-arterial arch and communicating system were observed again. Results The diameter of the 3rd intestinal artery was the largest among the 1 st to 5th intestinal arteries. The length of jejunum vascularized by 3rd intestinal artery can be as long as （ 142. 2 ±62. 3） （69. 0 -206. 60cm） in acetic ester infiltrated specimens. While in ABS cast specimen, the average available extent of donor jejunum was（ 30. 8 ± 7. 3 ） （ 23.0 - 37. 3cm）. Conclusion As observed by this applied anatomy study, the jejunum graft vascularized by 3rd intestinal artery alone has sufficient length to meet the need of esophageal reconstrution.