mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/2072-3180-2023-3-17-26mossj-697Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWВариантная анатомия нижней брыжеечной артерии и ее значение при выборе уровня перевязки. Обзор литературыVariant anatomy of the inferior mesenteric artery and its significance when choosing the level of ligation. Literature reviewhttps://orcid.org/0000-0001-9103-6073ЕрмаковИ. В.ErmakovI. V.

Ермаков Игорь Викторович – кандидат медицинских наук, ассистент кафедры факультетской хирургии № 1 лечебного факультета РНИМУ им. Н.И. Пирогова.

117997, ул. Островитянова, д. 1, Москва

Igor V. Ermakov – Candidate of Medical Sciences, Assistant, Pirogov Russian National Research Medical University (Pirogov Medical University).

117997, Ostrovityanova st. 1, Moscow

iermakov0588@gmail.comhttps://orcid.org/0009-0003-2697-3441ШихинИ. С.ShikhinI. S.

Шихин Иван Сергеевич – клинический ординатор кафедры факультетской хирургии № 1 лечебного факультета РНИМУ им. Н.И. Пирогова.

117997, ул. Островитянова, д. 1, Москва

Ivan S. Shikhin – Surgeon resident, Pirogov Russian National Research Medical University (Pirogov Medical University).

117997, Ostrovityanova st. 1, Moscow

is.shikhin@yandex.ruhttps://orcid.org/0000-0002-4839-0584ГасановМ. М.GasanovM. M.

Гасанов Магамада Маллялиевич – кандидат медицинских наук, доцент кафедры факультетской хирургии № 1 лечебного факультета РНИМУ им. Н.И. Пирогова.

117997, ул. Островитянова, д. 1, Москва

Magamada M. Gasanov – Candidate of Medical Sciences, Associate Professor, Pirogov Russian National Research Medical University (Pirogov Medical University).

117997, Ostrovityanova st. 1, Moscow

mmg-1@mail.ruhttps://orcid.org/0000-0002-8629-8252АтрощенкоА. О.AtroshchenkoA. O.

Атрощенко Андрей Олегович – кандидат медицинских наук, врач-онколог ГБУЗ «ММКЦ «Коммунарка» ДЗМ».

108814, Россия, Москва, п. Коммунарка, ул. Сосенский стан, д. 8

Andrey O. Atroshchenko — Candidate of Medical Sciences, Oncologist surgeon, Moscow Multidisciplinary Clinical Center «Kommunarka».

108814, Sosensky Stan st. 8, Moscow

dr.atroshchenko@gmail.comhttps://orcid.org/0000-0001-6188-6093СажинА. В.SazhinA. V.

Сажин Александр Вячеславович – член-корреспондент РАН, доктор медицинских наук, профессор, заведующий кафедрой факультетской хирургии № 1 лечебного факультета РНИМУ им. Н.И. Пирогова.

117997, ул. Островитянова, д. 1, Москва

Alexander V. Sazhin – Doctor of Medical Sciences, Professor, Head of department, Pirogov Russian National Research Medical University (Pirogov Medical University).

117997, Ostrovityanova st. 1, Moscow

sazhin-AV@yandex.ruФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияFederal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Health of the Russian FederationRussian FederationГосударственное бюджетное учреждение здравоохранения города Москвы «Московский многопрофильный клинический центр «Коммунарка» Департамента здравоохранения города Москвы»РоссияState Budgetary Institution of healthcare of the city of Moscow «Moscow Multidisciplinary Clinical Center «Kommunarka» of the Department of Healthcare of the City of Moscow»Russian Federation202324092023031726Copyright © Ермаков И.В., Шихин И.С., Гасанов М.М., Атрощенко А.О., Сажин А.В., 20232023Ермаков И.В., Шихин И.С., Гасанов М.М., Атрощенко А.О., Сажин А.В.Ermakov I.V., Shikhin I.S., Gasanov M.M., Atroshchenko A.O., Sazhin A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/697Введение

Введение. В хирургии колоректального рака (КРР) высокая перевязка нижней брыжеечной артерии (НБА) является «золотым» стандартом. Низкая перевязка НБА может снижать частоту несостоятельности анастомоза.

Цель исследования

Цель исследования. Изучить вариантную анатомию НБА и определить ее значение при выборе уровня перевязки.

Материалы и методы исследования. Проведен поиск исследований в электронной базе данных PubMed и eLIBRARY. В окончательный обзор и анализ включено 30 статей.

Результаты

Результаты. В практической деятельности наибольший интерес представляет классификация Yada-Murono, согласно которой выделяют 4 типа анатомии НБА: I тип – левая ободочная артерия (ЛОА) отходит изолировано от НБА; II тип – ЛОА и сигмовидная артерия (СА) имеют общий ствол; III тип – ЛОА, СА и верхняя прямокишечная артерия (ВПА) исходят веерообразно из одной точки; IV – ЛОА отсутствует.

Обсуждение

Обсуждение. Сохранение ЛОА у пациентов с I типом не вызывает сложностей. При II типе низкая перевязка за счет короткой НБА может стать причиной натяжения зоны анастомоза и развития несостоятельности. У пациентов с III типом необходимо стремиться сохранить ЛОА, т. к. высокая перевязка сопровождается гипоперфузией левых отделов ободочной кишки. Для IV типа поиск ЛОА сопряжен с риском выхода из слоя и повреждением соседних структур.

Заключение

Заключение. Оценка анатомии НБА имеет практическое значение в хирургии КРР, позволяя выбрать оптимальный уровень ее пересечения.

Introduction

Introduction. In colorectal cancer surgery, high ligation of the inferior mesenteric artery (IMA) is the "gold" standard. Low ligation of the IMA can decrease the frequency of anastomotic leakage.

Aim

Aim: to study the variant anatomy of the IMA and determine its significance when choosing the level of ligation.

Materials and methods

Materials and methods. The research is based on the PubMed and eLIBRARY articles, 30 of which are included in the final review and analysis.

Results

Results. In practice, the classification of Yada-Murono is of the greatest interest, according to which there are 4 types of the IMA anatomy: type I – left colic artery (LCA) emanates from IMA independently; type II – LCA and sigmoid artery (SA) co-trunk; type III – LCA, SA and superior rectal artery (SRA) emanate from the same point; type IV – LCA is absent.

Discussion

Discussion. Preservation of the LCA in patients with type I does not cause difficulties for the surgeon. With type II, low ligation due to a short IMA can cause tension of the anastomosis area and the development of anastomotic leakage. For patients with type III, preserving LCA is necessary because high ligation is accompanied by hypoperfusion and more frequent anastomotic leakages. For patients with type IV, the search for LCA is associated with the risk of damaging neighboring structures.

Conclusion

Conclusion. Assessment of the IMA anatomy and its branches is of practical importance in colorectal cancer surgery in order to choose the optimal level of its ligation.

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The authors declare that there are no conflicts of interest present.