Objective To evaluate and analyze the classification and anatomical characteristics of the inferior mesenteric artery (IMA) of patients with rectal cancer by three-dimensional CT angiography (CTA) in order to provide reference for the surgical management of rectal cancer. Methods A retrospective analysis was performed on the clinical and image data of rectal cancer patients received IMA CTA examinations in Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2018 to December 2019. IMA images were reconstructed by three-dimensional CT angiography. Branch types of IMA were classified, and anatomical parameters of the inferior mesenteric vessel were measured and analyzed. Results Among the 266 cases, 187 were males and 79 were females. The left colon artery (LCA) arose independently from the common trunk in 111 cases (accounting for 41.7%). In 112 cases (accounting for 42.1%), the LCA and sigmoid colon artery (SA) had a common trunk, and in 33 cases (accounting for 12.4%), LCA, SA and superior rectal artery (SRA) forked at same point, whereas LCA disappeared in 10 cases (accounting for 3.8%). The length of the IMA (LIMA) was (39.1±10.1) mm, and the distance between the IMA root and iliac aortic bifurcation (DIMA) was (44.1±7.4) mm. The distance from the IMA root to the inferior mesenteric vein (IMV) and the IMA branch point to the IMV were (24.6±8.9) mm, (13.0±5.3) mm, respectively. In 122 cases (accounting for 47.6%), LCA ascended medial to the lateral border of left kidney, while in 46 patients (accounting for 18.0%), LCA arranged below the inferior border of left kidney. LCA located medial to IMV at the level of IMA root in 65 cases (accounting for 25.4%), just lateral to IMV in 136 cases (accounting for 53.1%), and lateral away from IMV in 55 cases (accounting for 21.5%). Conclusions Three-dimensional CT angiography before surgery can accurately assess the IMA branch types and anatomical parameters of the inferior mesenteric vessel, which can provide reference for vascular management in rectal cancer surgery.
Key words
Rectal cancer /
Inferior mesenteric artery /
/
/
Three-dimensional CT angiography /
/
/
Vascular variation
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Cirocchi R, Randolph J, Cheruiyot I, et al. Systematic review and meta-analysis of the anatomical variants of the left colic artery[J]. Colorectal Dis, 2020, 22(7): 768-778. DOI:10.1111/codi.14891.
[2] Murono K, Kawai K, Kazama S, et al. Anatomy of the inferior mesenteric artery evaluated using 3-dimensional CT angiography[J]. Dis Colon Rectum, 2015, 58(2):214-219. DOI:10.1097/DCR.0000000 000000285.
[3] Yada H, Sawai K, Taniguchi H, et al. Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer[J]. World J Surg, 1997, 21(1): 109-115. DOI:10.1007/s002689900202.
[4] Zebrowski W, Augustyniak E, Zajac S. Variations of origin and branching of the interior mesenteric artery and its anastomoses[J]. Folia Morphol (Warsz), 1971, 30(4): 575-583.
[5] Latarjet A. Traite d’anatomie humaine. In: Tome quatrieme: Appareil de la Digestion[M]. Paris: G Doin & Cie,1949.
[6] 李若坤, 强金伟, 廖治河, 等. 多层螺旋CT肠系膜动脉造影的三维解剖学研究[J].中国临床解剖学杂志, 2008, 26(5): 521-524. DOI:10.13418/j.issn.1001-165x.2008.05.042.
[7] 刘跃跃,师毅冰.三维CT血管造影在右肺上叶静脉解剖中的应用[J].中国临床解剖学杂志,2019, 37(2): 139-141. DOI:10.13418/j.issn. 1001-165x.2019.02.005.
[8] Miyamoto R, Nagai K, Kemmochi A, et al. Three-dimensional reconstruction of the vascular arrangement including the inferior mesenteric artery and left colic artery in laparoscope-assisted colorectal surgery[J]. Surg Endosc, 2016, 30(10): 4400-4404. DOI:10.1007/s00464-016-4758-4.
[9] Ke J, Cai J, Wen X, et al. Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: Insights into rectal cancer surgery - A retrospective observational study[J]. Int J Surg, 2017, 41:106-111. DOI:10.1016/j.ijsu.2017.03.012.
[10]Fujii S, Ishibe A, Ota M, et al. Short-term and long-term results of a randomized study comparing high tie and low tie inferior mesenteric artery ligation in laparoscopic rectal anterior resection: subanalysis of the HTLT (High tie vs. low tie) study[J]. Surg Endosc. 2019;33(4): 1100-1110. DOI:10.1007/s00464-018-6363-1.
[11]申占龙, 鲍予頔, 叶颖江, 等. 直肠癌根治术中肠系膜下动脉高位和低位结扎的争议与思考[J]. 中华外科杂志, 2020, 58(7): 596-599. DOI:10.3760/cma.j.cn112139‑20200330‑00266.
[12]Bonnet S, Berger A, Hentati N, et al. High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses[J]. Dis Colon Rectum. 2012, 55(5): 515-521. DOI:10.1097/DCR.0b013e318246f1a2.
[13]Yang Y, Wang G, He J, et al. High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a meta‑analysis[J]. Int J Surg, 2018, 52: 20‑24. DOI:10.1016/j.ijsu.2017.12.030.
[14]Trencheva K, Morrissey KP, Wells M, et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients[J]. Ann Surg, 2013, 257(1): 108‑113. DOI:10.1097/SLA.0b013e318262a6cd.
[15]滕文浩, 魏丞, 刘文居, 等. 保留左结肠动脉对接受新辅助治疗的直肠癌患者术后吻合口漏的影响[J].中华胃肠外科杂志, 2019, 22(6): 566‑572. DOI:10.3760/cma.j.issn.1671-0274.2019.06.010.
[16]Guo Y, Wang D, He L, et al. Marginal artery stump pressure in left colic artery‑preserving rectal cancer surgery: a clinical trial[J]. ANZ J Surg, 2017, 87(7‑8): 576‑581. DOI:10.1111/ans.13032.
[17]焦裕荣, 何金杰, 李军, 等. 腹腔镜完整结肠系膜切除术相关血管变异与术中出血的应对措施[J].中华胃肠外科杂志, 2018, 21(3): 259-266. DOI:10.3760/cma.j.issn.1671-0274.2018.03.004.
PDF(4182 KB)
