肠系膜下动脉CTA分型与结直肠癌淋巴结转移相关性的研究

Lymph node metastasis of colorectal cancer is associated with inferior mesenteric artery branching patterns by CTA

关键词:  结直肠  CTA  肠系膜下动脉  淋巴结转移

Key words:  inferior mesenteric artery（IMA）  CTA  lymph node metastasis  colorectal cancer

摘要:

目的　通过了解肠系膜下动脉(IMA)的分支及变异情况及其淋巴结转移规律，指导结、直肠癌手术中血管处理及淋巴结廓清。方法　选取大连医科大学附属第一医院胃肠外科和肛肠外科2014年4月至2014年10月间共55例结直肠癌患者，其中乙状结肠癌16例，直肠癌39例，通过肠系膜下动脉CTA结合术中所见，对IMA分支情况进行分型，在CTA上详细测量血管的相关数据并追踪术后病理结果，比较、分析各种分型的淋巴结检出数目及转移情况。结果　55例IMA均发自腹主动脉，IMA根部距离腹主动脉分叉的距离为（3.90±1.11）cm，IMA根部至第1分支处距离为（3.17±0.90）cm。IMA 分型中，A型，共4例（7.27%）；B型，共11例（20%）；C型，共40例（72.73%），淋巴结转移度与IMA的分型之间有关联。左结肠动脉1支有32例(58.18%),2支23例(41.82%)；乙状结肠动脉（SA）分支情况为: 1支9例(16.36%), 2支35例(63.64%)，3支11例(20%)。SA 1支时，第1站淋巴结转移度8.73%；第2站淋巴结转移度16.28%；第3站淋巴结转移度5.88%；SA分支数2支及以上时，第1站淋巴结转移度19.96%；第2站淋巴结转移度33.34%；第3站淋巴结转移度9.09%。淋巴结转移度与SA的分支数有关。结论　术前行CTA可有助判断其变异及分支情况，从而指导更合理的处理血管及淋巴结的廓清。

Abstract:

Objective　To investigate the relationship between lymph node metastasis of colorectal cancer and inferior mesenteric artery (IMA) branching patterns by CT angiography (CTA), in order to guide the surgery for colorectal cancer. Methods　Clinical data of 55 patients from the First Affiliated Hospital of Dalian Medical University were collected and analyzed, including 39 rectum carcinoma and 16 sigmoid carcinoma. The patients underwent CTA preoperatively for IMA branching pattern. Three types of branching were confirmed: Type A, three arteries branching off from the same point; Type B, SA branching off from LCA; and Type C, SA branching off from SRA. Pathological results of each patient were collected and analyzed for possible relationship between IMA types and lymph node metastasis. Results　IMA was originated from abdominal aorta in all 55 patients. The mean distance between the root of IMA and the abdominal aortic bifurcate was (3.90±1.11)cm; while the mean distance between the root of IMA and its first branching point was (3.17±0.90) cm. The number of lymph nodes obtained during surgery and the extent lymph node metastasis were correlated with IMA types, the extent of lymph node metastasis was significantly associated with the number of SA branches. Conclusion　Preoperative CTA is an effective method to assess the type of IMA and its branches, thus can guide more reasonable blood vessel handling and lymph node dissection.