KHẢO SÁT ĐẶC ĐIỂM ĐỘNG MẠCH MẠC TREO TRÀNG TRÊN Ở NGƯỜI TRƯỞNG THÀNH BẰNG CẮT LỚP VI TÍNH

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Tác giả: Đại Hùng Linh Nguyễn, Hoàng Thanh Tú Nguyễn, Tín Trung Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Điện quang và Y học hạt nhân Việt Nam, 2024

Mô tả vật lý: tr.32-39

Bộ sưu tập: Báo, Tạp chí

ID: 414859

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Mục tiêu: Nghiên cứu đặc điểm giải phẫu động mạch (ĐM) mạc treo tràng trên (MTTT) ở người trưởng thành bằng cắt lớp vi tính. Phương pháp: Nghiên cứu mô tả cắt ngang thực hiện trên 218 bệnh nhân chụp cắt lớp vi tính vùng bụng tại Bệnh viện Ung Bướu TPHCM từ tháng 01/2023 đến tháng 05/2023. Chúng tôi khảo sát về nguyên ủy, đường kính ĐM MTTT, các biến thể, tương quan mạch máu kết tràng phải trong không gian. Kết quả: ĐM MTTT hầu hết xuất phát từ động mạch chủ (97,2%), chủ yếu ngang mức thân sống L1 với gần 70%. Ngoài các nhánh kinh điển, chúng tôi ghi nhận ĐM MTTT có phân nhánh ĐM gan phải (15 trường hợp) và ĐM lách (1 trường hợp). Đường kính trung bình ĐM MTTT là 7,07 ± 1,10 mm. Giá trị bình thường đường kính ĐM MTTT của nữ nhỏ hơn nam (p<
0,05). ĐM hồi kết tràng xuất hiện trong tất cả các ca và 60,5% đi phía sau tĩnh mạch (TM) MTTT. ĐM kết tràng phải thấy trong 30,7% trường hợp và 91,2% đi trước TM MTTT. Có 21,1% trường hợp có ĐM kết tràng phải phụ. Khi ĐMHKT đi trước ĐMMTTT, nếu có ĐMKTP thì ĐMKTP cũng đi phía trước TM MTTT trong tất cả các ca. Về tương quan trong không gian ba chiều giữa ĐM và TM MTTT thì dạng IV (không có ĐM kết tràng phải và ĐM hồi kết tràng đi sau TM MTTT) chiếm nhiều nhất (41,5%). Độ dài trung bình bắt chéo TM MTTT của ĐM kết tràng phải và ĐM hồi kết tràng lần lượt là 19,02 ± 3,66 mm và 11,35 ± 2,87 mm. Khoảng cách giữa nguyên ủy ĐM kết tràng phải và ĐM hồi kết tràng là 13,33 ± 4,09 mm. Kết luận: Cắt lớp vi tính là phương pháp không xâm lấn và đáng tin cậy, có thể cung cấp chính xác về giải phẫu của động mạch mạc treo tràng trên, mối tương quan không gian với tĩnh mạch mạc treo tràng trên, giúp lên kế hoạch phẫu tích mạch máu và nạo hạch cũng như ngăn ngừa tổn thương mạch máu trong phẫu thuật nội soi ung thư kết tràng phải.Objectives: The study aimed to perform an anatomical analysis of the superior mesenteric artery (SMA) in Vietnamese adults by using multidetector computed tomography (MDCT). Methods: A cross-sectional and predominantly descriptive study, utilizing arterial phase contrast-enhanced MDCT images of 218 patients from January 2023 to May 2023 at Oncology Hospital Ho Chi Minh City. The MDCT images were meticulously reviewed to identify the origin, diameter, variations of the SMA, colic pattern of SMA, and the topographic relationship between the ileocolic artery (ICA), right colonic artery (RCA) and the superior mesenteric vein (SMV). Results: The study findings demonstrated that SMA primarily originated from the aorta (97.2%), predominantly at the level of the L1 vertebral body (70%). Furthermore, apart from the branches commonly observed, the study identified the presence of branching of the right hepatic artery in 15 cases, as well as one case of the splenic artery. The mean diameter of SMA was determined to be 7.07 ± 1.10 mm, with women displaying a smaller diameter compared to men (p<
0.05). The ICA was present in all cases, with the ICA running dorsal to the SMV in 60.5% of instances. The RCA was found in only 30.7% of cases and ran ventral to the SMV in the majority of cases (91.2%)
furthermore, 21.1% of cases presented an accessory RCA. When the ICA was noted to traverse the ventral aspect of the SMV, the RCA likewise coursed ventral to the SMV in all cases. Type IV, the most common topographical relationship observed between the branches of the SMA and the SMV (41,5%), is characterized by the absence of the RCA and the ICA running ventral to the SMV. The mean RCA and ICA crossing length was 19.02 ± 3.66 mm and 11.35 ± 2.87 mm, respectively. The ICA to RCA distance was 13.33 ± 4.09 mm. Conclusion: MDCT is a reliable and noninvasive method that can provide anatomical accuracy of the SMA, as well as their intersectional pattern with the SMV, bears considerable importance in the strategic planning of surgical interventions and serves as a valuable tool in mitigating the occurrence of unforeseen vascular injuries during laparoscopic right-sided colon surgery.

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