腹腔镜外科杂志2026，Vol.31Issue(4)：268-273,6.DOI:10.13499/j.cnki.fqjwkzz.2026.04.268
多层螺旋CT血管造影辅助精准保留左结肠动脉在腹腔镜直肠前切除术中的应用
Application of multi-slice spiral CT angiography-assisted accurate preservation of the left colic artery in laparoscopic anterior rectal resection
摘要
Abstract
Objective:To explore the application value of accurately preserving the left colic artery(LCA)with the assistance of judging the inferior mesenteric artery(IMA)classification by multi-slice spiral CT angiography(CTA)during laparoscopic anterior rectal resection.Methods:The clinical data of 203 rectal cancer patients who underwent laparoscopic anterior rectal resection from Jan.2022 to Dec.2023 were collected.Preoperative abdominal CTA was used to analyze the classification and length of IMA,except for the type without LCA,the LCA was accurately separated and preserved.Meanwhile,perioperative conditions(operative time,intraoperative blood loss,time to postoperative first flatus,hospital stay,defunctioning stoma,etc.),postoperative pathological data(TNM stage,total lymph nodes harvested,and number of positive lymph nodes),and postoperative recovery(anastomotic leakage and urinary retention)were recorded.Results:The IMA classification was determined by abdominal CTA reconstruction,including 88 cases of type Ⅰ(43.35%),52 cases of type Ⅱ(25.62%),48 cases of type Ⅲ(23.64%),and 15 cases of type Ⅳ(7.39%).All procedures were completed successfully without conversion to open surgery,and the intraoperative verification showed that the coincidence rate between IMA classification and preoperative abdominal CTA judgment was 100%.Significant difference in intraoperative blood loss was observed among different IMA types,with more intraoperative blood loss in type Ⅲ(P=0.026).No significant differences were found in IMA length,operative time,defunctioning stoma rate,postoperative pathological stage,total number of lymph nodes harvested,number of posi-tive lymph node,time to postoperative first flatus,postoperative hospital stay,abdominal drainage tube indwelling time,urinary catheter indwelling time,and incidence of anastomotic leakage and urinary dysfunction(P>0.05).Conclusions:Preoperative accurate classifica-tion of IMA by abdominal CTA is helpful for preoperative evaluation of anatomical variations of IMA,and provides safe intraoperative navigation for preserving the LCA in laparoscopic rectal cancer surgery.关键词
直肠前切除术/腹腔镜检查/肠系膜下动脉分型/左结肠动脉/腹部 CT 血管造影Key words
Anterior resection of the rectum/Laparoscopy/Inferior mesenteric artery classification/Left colic artery/Abdominal computed tomography angiography分类
医药卫生引用本文复制引用
韦垒,骆洋,钟鸣,吕强..多层螺旋CT血管造影辅助精准保留左结肠动脉在腹腔镜直肠前切除术中的应用[J].腹腔镜外科杂志,2026,31(4):268-273,6.基金项目
上海市浦东新区卫生健康委员会卫生计生科研项目(PW2022B-10) （PW2022B-10）
