Fujiwara Michitaka, Kodera Yasuhiro, Satake Hiroko, Misawa Kazunari, Miura Shinichi, Nakayama Goro, Ohashi Norifumi, Koike Masahiko, Nakao Akimasa
Department of Surgery II, School of Medicine, Nagoya University 65, Tsurumai-cho, Showa-ku, Nagoya, Japan.
Hepatogastroenterology. 2008 Jul-Aug;55(85):1201-5.
BACKGROUND/AIMS: Early-stage gastric cancer is one relatively well-explored target for laparoscopic resection. Systemic lymphadenectomy is considered an essential component of gastrectomy, however, it may not be easy even with extensive experience. It is convenient for the laparoscopists, therefore, to be given preoperatively thorough information regarding the vessels anatomy of the celiac branches around the stomach for each patient.
Between July 2001 and January 2006, 41 patients with gastric carcinoma scheduled for surgery underwent 3-dimensional computed tomography (3D-CT) examination at Nagoya University Hospital. From the 3D-CT images, information regarding the vessels that are dissected during surgery for gastric cancer was obtained, and the branching patterns of those were analyzed.
The left gastric artery and the right gastroepiploic artery were detected in all 41 cases, while the right gastric artery was detected only in 22 cases (53.7%). Variations in the origin of the left gastric and right gastroepiploic arteries were not observed. However, there was a considerable variation in the origin of the right gastric artery, with 50.0% branching from the proper hepatic artery, 22.7% from the left hepatic artery, and 13.6% from the gastroduodenal artery. In 4 cases (9.7%), the left hepatic artery was found to originate from the left gastric artery.
Preoperative knowledge of the basic vascular patterns obtained through 3D-CT imaging is a useful guide to safely perform laparoscopic gastrectomy, although further improvements in the processing of more detailed imaging is needed.
背景/目的：早期胃癌是腹腔镜切除相对研究较多的一个靶点。系统性淋巴结清扫被认为是胃切除术的重要组成部分，然而，即便经验丰富，实施起来也并非易事。因此，对于腹腔镜手术医生而言，术前为每位患者提供关于胃周围腹腔干分支血管解剖的详尽信息会很方便。
2001年7月至2006年1月期间，名古屋大学医院41例计划接受手术的胃癌患者接受了三维计算机断层扫描（3D-CT）检查。从3D-CT图像中获取了胃癌手术中所解剖血管的信息，并分析了这些血管的分支模式。
41例患者均检测到胃左动脉和胃网膜右动脉，而仅22例（53.7%）检测到胃右动脉。未观察到胃左动脉和胃网膜右动脉起源的变异情况。然而，胃右动脉的起源存在相当大的变异，50.0%起自肝固有动脉，22.7%起自肝左动脉，13.6%起自胃十二指肠动脉。4例（9.7%）发现肝左动脉起自胃左动脉。
通过3D-CT成像获得的术前基本血管模式知识是安全实施腹腔镜胃切除术的有用指南，尽管在更详细成像的处理方面还需要进一步改进。
