肠系膜下动脉CT动脉造影分型与淋巴结转移相关性研究

Correlation between lymph node metastasis of colorectal carcinoma and vascular pattern of inferior mesenteric artery by CTA

目的通过CT动脉造影(CTA)对肠系膜下血管(IMA)分型,研究其对结直肠手术的指导价值。方法随机选取大连医科大学附属第一医院2011年1月至2013年4月间77例接受腹腔镜辅助结直肠癌手术病人采用容积再现(VR)血管生长技术(AV)进行血管重建,对IMA及其分支的变异进行分型。结果 77例IMA均发自腹主动脉。根据左结肠动脉(LCA)、乙状结肠动脉(SA)及直肠上动脉(SRA)的起点,IMA的变异可分为4种类型,A型为三分支均发自同一起点;B型为SA发自LCA;C型为SA发自SRA;D型为SA分别发自LCA及SRA。上述分型与年龄、性别、肿瘤浸润深度、淋巴结转移以及肿瘤距肛门距离无统计学相关性,而淋巴结转移与肿瘤距肛门距离显著相关(P=0.002)。结论 IMA的变异较大,其中No.242淋巴结转移与SA变异相关。术前行IMA CTA有助于腹腔镜手术下寻找并保留LCA及减少淋巴结清扫不彻底。

Objective To study vascular pattern of inferior mesenteric artery（IMA） by CT angiography（CTA） forcolorectal operation.Methods Seventy-seven patients with colorectal carcinoma underwent preoperative IMA CTAfrom January 2011 to April 2013 in the First Affiliated Hospital of Dalian Medical University were selected randomly.IMA and its branches were reconstructed by VR-r AV technique and divided into different categories.Results All thepatients’ IMA branched off the abdominal aorta. Four types of branching were confirmed. Type A,where the threearteries branched off from the same point; Type B,where SA branched off from LCA; and Type C,where SA branched offfrom SRA; Type D,where SA branched off from LCA and SRA respectively. There was no statistical relation betweentyping and age,gender,invasive depth of tumor,lymph node metastasis,distance from tumor to anus. But lymph nodemetastasis had significant associated with the distance from tumor to anus（P=0.002）.Conclusion Aberrance of IMA isvarious,metastasis of 242 group lymph nodes was associated with aberrance of SA. Performing preoperative IMA-CTA ishelpful to preserve LCA and reduce inadequate lymph node dissection.