腹腔干-肠系膜上动脉共干多层螺旋CT血管成像与胚胎发生机制分析

Multi-slice Spiral CT Angiography of Celio-mesenteric Trunk and the Embryogenesis Mechanism

目的采用多层螺旋CT(MSCT)血管成像探讨腹腔干-肠系膜上动脉共干(CMT)的构型、类型、伴随病变及其他分支变异,分析并推测各型CMT的胚胎发生机制。资料与方法回顾性分析1500例患者的上中腹部或全腹部MSCT增强扫描及血管成像数据,选择符合CMT的病例纳入本研究,评价其构型、主要分支的起源、伴随病变及其他分支变异。结果 1500例患者中,51例(3.4%)属于CMT。按照共同动脉单干的长度CMT可分为长型(34例,66.7%)和短型(17例,33.3%);按照胃左动脉的起源,除2例因胃左动脉起源难以确定而未纳入分型外,49例CMT可分为A型(胃左动脉起源于腹主动脉,26例,53.1%)、B型(胃左动脉起源于共同动脉单干,5例,10.2%)、C型(胃左动脉起源于腹腔干,15例,30.6%)及D型(胃左动脉起源于其他分支,3例,6.1%)。结论在胚胎发育过程中,腹侧纵向吻合错位中断、不完全或完全不中断可能是各型CMT的胚胎发生机制。MSCT血管成像有助于了解CMT及其他动脉的解剖变异,为腹部血管外科和介入治疗方案的制订提供依据。

Purpose To explore the configuration, type, complication and other branch variations of celio-mesenteric trunk （CMT） with multi-slice CT （MSCT）, and to analyze and speculate embryogenesis mechanism of various types of CMT. Materials and Methods 1500 patients underwent upper middle abdomen or whole abdomen enhanced MSCT scans were enrolled in this retrospective study. Those angiography data in line with CMT were included to evaluate the configuration, origins of the main branches, complications and other branch variations. Results Fitly-one patients out of 1500 （3.4%） were considered as CMT. In terms of length they were divided into long type （34 cases, 66.7%） and short type （17 cases, 33.3%）. In terms of origin of left gastric artery, except lbr the 2 cases with difficulty in identifying the origin of left gastric artery who were excluded, other 49 cases of CMT were grouped into type A （26 cases originated from abdominal aorta, 53. 1%,）, type B （5 cases originated from common truck, 10.2%）, type C （15 cases originated from celiac trunk, 30.6%） and type D （3 cases originated from other branches, 6.1%）. Conclusion In the process of embryogenesis, mislocation interrupt, incomplete interrupt or without interrupt of ventral longitudinal anastomosis may be the embryological mechanism of various types of CMT. MSCT angiography can be helpful in observation on anatomy of CMT and other branch variations, thus guiding treatment plan for abdominal vascular surgery and interventional therapy.