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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 evaluate the value of subarachnoid vessels (IMA) classification by CT angiography (CTA) to evaluate its value in colorectal surgery. Methods Totally 77 patients undergoing laparoscopic assisted colorectal cancer surgery from January 2011 to April 2013 at First Affiliated Hospital of Dalian Medical University were enrolled in this study. Volume reconstruction (VR) The variation of its branches is typed. Results 77 cases of IMA were from the abdominal aorta. According to the origin of the left colonic artery (LCA), sigmoid colon (SA) and rectal artery (SRA), there are four types of IMA variation. The three types of type A are all originated from the same origin. LCA; type C for SA from SRA; type D for SA from LCA and SRA, respectively. There was no significant correlation between the above classification and age, sex, depth of tumor invasion, lymph node metastasis and the distance from the anus. Lymphatic metastasis was significantly associated with the anorectal distance (P = 0.002). Conclusion The variation of IMA is large, and No.242 lymph node metastasis is associated with SA mutation. Preoperative IMA CTA helps to look for and preserve LCA under laparoscopic surgery and to reduce lymph node dissection is not complete.