摘要
目的观察右半结肠血管走行和变异情况，探讨CT血管成像和CT结肠成像及图像融合技术对腹腔镜右半结肠癌手术前评估的临床价值。方法采用回顾性描述性研究方法。收集2015年1月至2017年7月南京医科大学附属无锡第二医院收治的38例行腹腔镜扩大右半结肠癌D，根治术患者的临床病理资料。患者术前行腹、盆腔CT平扫及增强扫描，将原始图像进行CT血管成像和CT结肠成像重建，并将其融合，得到血管及肠道的三维图像。观察指标：（1）肠系膜上动脉的分支情况。（2）肠系膜上动脉与肠系膜上静脉的位置关系。（3）胃结肠静脉干组成情况。结果38例患者CT结肠成像检查融合血管和原发肿瘤的扫描图像均达到诊断要求并获得良好的血管成像效果。容积再现图像上的各血管与术中镜下所见裸化血管的走行情况进行对比，吻合率为100．0％（38／38）。（1）肠系膜上动脉的分支情况：CT血管成像检查和术中解剖结果示38例患者右结肠动脉出现率为94．7％（36／38），中结肠动脉出现率为92．1％（35／38），回结肠动脉出现率为100．0％（38／38）。28例患者存在1支右结肠动脉。10例患者存在右结肠动脉结构变异，其中3例出现2支右结肠动脉，2例右结肠动脉缺如，2例出现右结肠动脉和中结肠动脉共干后再汇人肠系膜上动脉，3例右结肠动脉与回结肠动脉共干后再汇入肠系膜上动脉。（2）肠系膜上动脉与肠系膜上静脉的位置关系：CT血管成像检查和术中解剖结果示38例患者肠系膜上动脉和肠系膜上静脉出现率均为100．O％（38／38）；其中20例肠系膜上动脉位于肠系膜上静脉腹侧，18例肠系膜上动脉位于肠系膜上静脉背侧。（3）胃结肠静脉干组成情况：CT血管成像检查和术中解剖结果示38例患者中29例出现胃结肠静脉干，其属支共有右结肠静脉、中结肠静脉、胃网膜右静脉和胰十二指肠上前静脉4个来源。29例出现胃结肠静脉干患者中，18例由胃网膜右静脉和中结肠静脉、右结肠静脉构成2支型或3支型胃结肠干，3例由胃网膜右静脉和胰十二指肠上前静脉构成2支型胃胰干，8例由胃网膜右静脉、胰十二指肠上前静脉、右结肠静脉和中结肠静脉构成3支或4支型胃胰结肠干。结论CT血管成像、CT结肠成像及图像融合技术可以直观地显示右半结肠和血管解剖及变异具有较高的临床应用价值。
Objective To observe the distribution and variation of right colonic vessels, and investigate the clinical value of computed tomography angiography （ CTA）, computed tomography eolonography （ CTC ） and image fusion technology in preoperative evaluation of laparoscopic right colonic cancer （RCC）. Methods The retrospective and descriptive study was conducted. The clinieopathological data of 38 patients who underwent laparoscopic extended radical resection of RCC ＋ D3 lymphadenectomy in the Affiliated Wnxi Second People＇s Hospital of Nanjing Medical University between January 2015 and July 2017 were collected. Patients received preoperative plain and enhanced scans of abdominal and pelvic CT. The original images were reconstructed and fused by CTA and CTC, and then coming out with three-dimensional images of blood vessels and gut. Observation indicators ： （ 1 ） branches of superior mesenteric artery （SMA） ; （2） positional relationship between SMA and superior mesenteric vein （ SMV ） ; （ 3 ） composition of gastrocolic venous trunk. Results Scan images of 38 patients had fused with scan images of vessels and primary tumors and reached the diagnostic standard, with a good imaging performance. Distribution of blood vessels of virtual reality （VR） images and were compared with that of naked blood vessels under intraoperative laparoscopy, showing a coincidence rate of 100. 0% （38/38）. （1） Branches of SMA： results of CTA and intraoperative anatomy showed that the occurrence rate of the right colonic artery, middle colonic artery and ileocolic artery were respectively 94.7% （36/38）, 92. 1% （35/38） and 100. 0% （38/38）. A right colonic artery was found in 28 patients. Ten patients had structure variation of right colonic artery, including 3 with 2 right colonic arteries and 2 without right colonic artery. The right colonic artery and middle colonic artery merged into the same trunk and then flowed into SMA were detected in 2 patients; the fight colonic artery and ileoeolie artep/ merged into the same trunk and then flowed into SMA were detected in 3 patients. （2） Positional relationship between SMA and SMV： results of CTA and intraoperative anatomy showed that the occurrence rate of both SMA and SMV was 100. 0% （38/38）. The SMA in 20 patients was located in the ventral side of SMV; SMA in 18 patients was located in the dorsal side of SMV. （3） Composition of gastrocolic venous trunk： results of CTA and intraoperative anatomy showed that 29 of 38 patients had gastroeolie venous trunks, which belonged to four sources, including right colonic vein, middle colonic vein, right gastric epiploic vein and anterior superior pancreaticoduodenal vein. Among 29 patients, 18 had 2- or 3-branch type of gastrocolic trunk that consisted of the right gastric epiploie vein, middle colonic vein and right colonic vein; 3 had 2-branch type of gastric pancreatic trunk that consisted of the right gastric epiploie vein and anterior superior panereatieoduodenal vein; 8 had 3- or 4-branch type of stomach-pancreas-colon trunk that consisted of right gastric epiploic vein, anterior superior pancreaticoduodenal vein, right colonic vein and middle colonic vein. Conclusion anatomy and variation of fight colonic vessels,
作者
卞琳杰
巫丹萍
张追阳
倪建明
张雷
陈义钢
顾琛
Bian Linfie;Wu Danping;Zhang Zhuiyang;Ni Jianming;Zhang Lei;Chen Yigang;Gu Chen.(The Affiliated Wuxi Second People＇s Hospital of Nanjing Medical University, Wuxi 214002, Jiangsu Province, China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2018年第6期631-636,共6页
Chinese Journal of Digestive Surgery
基金
无锡市医院管理中心医学技术联合攻关项目（YGZXL1311）
关键词
结肠肿瘤
术前评估
血管重建技术
CT血管成像
CT结肠成像
扩大右半结肠癌切除术
腹腔镜检查
Colonic neoplasms
Preoperative evaluation
Vascular reconstruction
Computedtomography angiography
Computed tomography colonography
Extend right hemico-lectomy
Laparoscopy
