老年人肠系膜下动脉特点影像学分析

The angiographic anatomy of the inferior mesenteric artery in elder

目的探讨老年人肠系膜下动脉(IMA)的影像学特点。方法回顾性收集2017年1月至2018年12月在首都医科大学宣武医院普通外科因普通外科疾病择期行IMA数字减影血管造影的≥65岁患者的影像学资料。共纳入64例患者,男性42例,女性22例,年龄(70.9±5.1)岁(范围:60~88岁),观察IMA起始位置、直径、主干长度和分型,IMA根部水平肠系膜下静脉(IMV)与左结肠动脉(LCA)距离,以及IMA供应左侧结肠的范围。结果64例患者中,10例存在IMA狭窄,2例存在IMA闭塞。IMA直径为(3.2±0.5)mm(范围:2.6~4.4 mm),IMA主干长度为(3.8±1.0)cm(范围:1.1~7.0 mm)。分型Ⅰ型占40.6%(26/64),Ⅱ型占37.5%(24/64),Ⅲ型占18.8%(12/64),Ⅳ型占3.1%(2/64)。IMA根部水平IMV邻近LCA者占90.6%(58/64),远离LCA者占9.4%(6/64)。IMA供应范围达横结肠者占78.1%(50/64),供应至结肠脾曲者占17.2%(11/64),供应降结肠者占4.7%(3/64)。结论通过IMA造影等方法了解IMA特点、分型、血供范围及走行关系,可协助判断腹腔镜左侧结直肠癌根治术中血管的结扎位置,减少术后吻合口缺血等的发生。

Objective To examine the characteristics of the digital subtraction angiography of inferior mesenteric artery(IMA)in elderly Chinese patients over 65 years old.Methods Totally 64 cases who underwent angiography of IMA were selected from the Department of General Surgery,Xuanwu Hospital of Capital Medical University,including 42 males and 22 females,aging(70.9±5.1)years(range:60 to 88 years).The origin,diameter and trunk length of IMA were analyzed.The distribution of IMA branching and the relationship between LCA and IMV at the level of IMA opening position were revealed.Also,the range of IMA perfusion,Riolan arch and IMA occlusion were observed.Results All 64 patients underwent IMA angiography successfully.The diameter of IMA was(3.2±0.5)mm(range:2.6 to 4.4 mm),and the trunk length was(3.8±1.0)cm(range:1.1 to 7.0 mm).According to IMA classification standard,there were 26 patients with typeⅠ(40.6%),24 patients with typeⅡ(37.5%),12 patients with typeⅢ(18.8%),2 patients with typeⅣ(3.1%).The horizontal distance between IMV and LCA was less than 0.5 cm in 58 cases(90.6%)and more than 0.5 cm in 6 cases(9.4%).IMA perfusion was interrupted at the splenic flexure in elderly patients in 14 cases(21.9%),including 11 cases terminated at splenic flexure and 3 cases terminated at descending colon.Riolan arch was found in only 4 of 64 patients(6.2%).Two patients(3.1%)had IMA or its branch occlusion,the arterial perfusion were compensated by Drummond arch without Riolan arch.Conclusions The anatomy of IMA should be taken attention seriously in laparoscopic left-colorectal cancer radical resection.IMA shape,type,blood supply range and the relationship between LCA and IMV could be considered by the angiography or other examination,which can help to determine the ligation position of blood vessels,which could optimize the operation strategy.