肠系膜下动脉解剖特点及介入选择性插管应用分析

Anatomical features of inferior mesenteric artery and its influnce on selective interventional catheterization

目的分析肠系膜下动脉(IMA)解剖特点,探讨介入选择性插管优化方案。方法分析132例(中位年龄59.5岁)接受全腹部增强CT检查且肠系膜上下动脉均正常的病人影像资料,比较不同性别间肠系膜下动脉开口直径、开口距离髂动脉分叉垂直径、开口相对应腰椎平面位置及髂动脉分叉角度的差异。另外选择80例病人进行选择性IMA插管,其中40例采用C2导管成袢技术;另外40例采用非C2导管成袢技术,比较两组插管成功率,并分析插管失败原因。结果肠系膜上、下动脉均正常的病人中,男性病人的IMA开口的直径、开口距离髂动脉分叉的垂直径均大于女性病人的[男女比分别为(31.5±5.5)mm∶(27.2±4.7)mm;(42.9±6.7)mm∶(40.1±7.8)mm;均P<0.05],肠系膜下动脉开口部位及髂动脉分叉角度在两组间差异无统计学意义(P>0.05)。80例选择性肠系膜下动脉插管,采用C2导管成袢技术组的40例均选择性插管成功,而非C2导管成袢技术组,成功25例,失败15例(其中男性4例,女性11例),两组间比较成功率差异有统计学意义(P<0.01)。结论肠系膜下动脉管径较细,开口位置低,选择性插管采用C2导管成袢技术可提高成功率。

Objective To analyze the anatomical features of inferior mesenteric artery （IMA） and explore the optimal proposal of the selective IMA intubation. Methods 132 cases （median age 59.5 years old） whose superior mesenteric artery and IMA showed normal on enhanced CT were selected. The diameter of IMA opening, vertical lengths from the IMA openning to the common iliac artery bifurcation, lumbar plane corresponding to the IMA openning, and angle of iliac artery bifurcation were compared between male and female patients. Eighty patients underwent selective IMA intubation, among 40 of the 80 cases looped C2 catheter was used , and non-looped C2 catheter was used in the another 40 cases. Results The diameter of IMA opening and the vertical lengths from common iliac artery bifurcation were larger in male than in female patients （31.5±5.5 mm vs. 27.2±4.7 mm, P0.05）. Forty cases successed by using the techniques of looped C2 catheter.Twenty-five cases successed and Fifteen cases failed （male 4 cases, female 11 cases） by using the techniques of non-looped C2 catheter. There was statistical significance in success rate between the two groups （P〈0.01）. Conclusion IMA has a smaller diameter and low opening position. Selectively catheterization by using C2 catheter looping technology can improve the success rate.