摘要
目的:探讨术前胃周动脉三维重建在腹腔镜远端胃癌D2根治术中的临床意义。方法:将2018年10月至2019年10月入院的60例胃癌患者随机分为重建组及非重建组,每组各30例。对重建组患者应用Mimics软件行胃周动脉三维重建,所有患者均行腹腔镜远端胃癌根治术。比较两组手术时间、术中出血量、总淋巴结清扫数目、术后总引流量、术后并发症发生率。结果:重建组30例患者均重建显示腹主动脉、腹腔干、胃左动脉、脾动脉、肝总动脉、胃十二指肠动脉、肝固有动脉、肝左动脉及肝右动脉。其中22例显示胃右动脉,发现左、右膈下动脉自腹腔干发出1例,左膈下动脉自腹腔干发出2例,左膈下动脉、胰背动脉自腹腔干发出1例,胰背动脉自腹腔干发出1例,胃左动脉自腹主动脉发出2例,胃右动脉自胃十二指肠动脉发出2例,副肝左动脉自胃左动脉发出1例。重建组手术时间、术中出血量、术后总引流量均低于非重建组,差异具有统计学意义(P<0.05)。两组总淋巴结清扫数目、术后并发症发生率比较差异无统计学意义(P>0.05)。结论:Mimics软件可以清晰地对胃周动脉进行三维重建,便于术者术前准确评估胃周动脉走形及变异。术前行胃周动脉重建可缩短腹腔镜远端胃癌D2根治术手术时间,提高手术安全性,对手术方案的拟定具有较好的指导意义。
Objective:To investigate the clinical significance of preoperative 3d reconstruction of perigastric vessels in laparoscopic radical resection of distal gastric carcinoma D2.Methods:From October 2018 to October 2019,60 patients with gastric cancer who were hospitalized were randomly divided into the reconstruction group and the non-reconstruction group,with 30 patients in each group.Mimics software was used to conduct three-dimensional reconstruction of gastric periartery in the reconstruction group,and all patients underwent laparoscopic distal radical gastrectomy.The operative time,intraoperative blood loss,total number of lymph nodes dissected,total postoperative drainage volume and postoperative complication rate of the two groups were prospectively compared.SPSS23.0 software was used for statistical analysis,and P<0.05 was considered to be statistically significant.Results:A total of 60 cases were enrolled,including 30 in the reconstruction group and 30 in the non-reconstruction group.All the 30 patients in the reconstruction group were reconstructed with abdominal aorta,celiac trunk,left gastric artery,splenic artery,common hepatic artery,gastroduodenal artery,proper hepatic artery,left hepatic artery and right hepatic artery.The left inferior phrenic artery originated from the celiac trunk in 2 cases.The left inferior phrenic artery and dorsal pancreatic artery originated from the celiac trunk in 1 case.The dorsal pancreatic artery originated from the celiac trunk in 1 case.The left gastric artery originated from the abdominal aorta in 2 cases.The right gastric artery originated from the gastroduodenal artery in 2 cases.The left accessory hepatic artery originated from the left gastric artery in 1 case.The operative time,intraoperative blood loss and total postoperative drainage in the reconstruction group were all lower than those in the non-reconstruction group,with statistically significant differences(P<0.05).There was no statistical difference in the total number of lymph nodes dissected and the incidence of postoperative complications between the two groups(P>0.05).Conclusion:Mimics software can be used for clear 3d reconstruction of gastric artery,which is convenient for accurate preoperative evaluation of gastric artery configuration and variation.Preoperative reconstruction of perigastric artery can shorten the operation time and improve the safety of laparoscopic radical resection of distal gastric cancer D2.It has better guiding significance to the formulation of the operation plan.
作者
汪天时
臧义丰
WANG Tian-shi;ZANG Yi-feng(Department of Gastrointestinal Surgery,Second Hospital of Shandong University,Jinan 250033,China)
出处
《中国现代普通外科进展》
CAS
2020年第10期792-796,共5页
Chinese Journal of Current Advances in General Surgery
基金
济南市临床医学科技创新计划(201704125)。
关键词
胃肿瘤
外科治疗
腹腔镜
血管三维重建
Gastric neoplasm
Surgical treatment
Laparoscopy
Three-dimensional reconstruction of blood vessels
