<br>最大强度投影和三维重建视图下的肠系膜下动静脉图谱,Journal of Clinical Medicine

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最大强度投影和三维重建视图下的肠系膜下动静脉图谱
Journal of Clinical Medicine ( IF 3.0 ) Pub Date : 2024-02-02 , DOI: 10.3390/jcm13030879
Hongwei Zhang ₁ , Shurong Liu ₁ , Bingqi Dong ₁ , Jing Liu ₂ , Xiaochao Guo ₂ , Guowei Chen ₁ , Yong Jiang ₁ , Yingchao Wu ₁ , Junling Zhang ₁ , Xin Wang ₁

Affiliation

(1) 背景：了解血管模式对于最大限度地减少结直肠手术中的出血和手术时间至关重要。本研究旨在开发肠系膜下动脉（IMA）和静脉（IMV）的解剖图谱。 (2)方法：共纳入521例左侧结直肠癌患者。使用最大强度投影 (MIP) 和三维 (3D) 重建技术识别 IMA 和 IMV 模式。通过与手术视频进行比较来评估这些技术的准确性。我们比较了不同 IMA 类型的 IMA 结扎的出血量和手术时间。 (3)结果：大部分患者(45.7%)为I型IMA，其次为II型(20.7%)、III型(22.6%)和IV型(3.5%)。新发现的 V 型和 VI 型模式分别见于 6.5% 和 1% 的患者。在 IMV 中，49.9% 引流至肠系膜上静脉 (SMV)，38.4% 引流至脾静脉 (SPV)，9.4% 引流至 SMV-SPV 交界处，只有 2.3% 引流至第一空肠静脉 (J1V) 。在左结肠动脉（LCA）根部以上，13.1%的IMV没有分支，50.1%有1个分支，30.1%有2个分支，6.7%有3个或更多分支。两名患者有两个主要的 IMV 分支，十名患者在结肠系膜边缘有小分支的 IMV。在IMA根部，37.2%的LCA与IMV重叠，其中34.0%位于外侧，16.9%位于远端，8.7%位于内侧，边缘型IMV和持续性降结肠系膜（PDM）型均占1.4%。 MIP的准确率为98.43%，3D重建的准确率为100%。与 IMA 结扎的简单组相比，复杂组的失血量和手术时间显着更高 (p < 0.001)。 (4)结论：提供了完整的IMA和IMV解剖图谱。复杂的 IMA 模式与出血和手术时间的增加有关。

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The Atlas of the Inferior Mesenteric Artery and Vein under Maximum-Intensity Projection and Three-Dimensional Reconstruction View

(1) Background: Understanding vascular patterns is crucial for minimizing bleeding and operating time in colorectal surgeries. This study aimed to develop an anatomical atlas of the inferior mesenteric artery (IMA) and vein (IMV). (2) Methods: A total of 521 patients with left-sided colorectal cancer were included. IMA and IMV patterns were identified using maximum-intensity projection (MIP) and three-dimensional (3D) reconstruction techniques. The accuracy of these techniques was assessed by comparing them with surgical videos. We compared the amount of bleeding and operating time for IMA ligation across different IMA types. (3) Results: Most patients (45.7%) were classified as type I IMA, followed by type II (20.7%), type III (22.6%), and type IV (3.5%). Newly identified type V and type VI patterns were found in 6.5% and 1% of patients, respectively. Of the IMVs, 49.9% drained into the superior mesenteric vein (SMV), 38.4% drained into the splenic vein (SPV), 9.4% drained into the SMV–SPV junction, and only 2.3% drained into the first jejunal vein (J1V). Above the root of the left colic artery (LCA), 13.1% of IMVs had no branches, 50.1% had one, 30.1% had two, and 6.7% had three or more branches. Two patients had two main IMV branches, and ten had IMVs at the edge of the mesocolon with small branches. At the IMA root, 37.2% of LCAs overlapped with the IMV, with 34.0% being lateral, 16.9% distal, 8.7% medial, and both the marginal type of IMV and the persistent descending mesocolon (PDM) type represented 1.4%. MIP had an accuracy of 98.43%, and 3D reconstruction had an accuracy of 100%. Blood loss and operating time were significantly higher in the complex group compared to the simple group for IMA ligation (p < 0.001). (4) Conclusions: A comprehensive anatomical atlas of the IMA and IMV was provided. Complex IMA patterns were associated with increased bleeding and operating time.

更新日期：2024-02-02

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