Egorov Viacheslav I, Yashina Nina I, Fedorov Andrey V, Karmazanovsky Gregory G, Vishnevsky Vladimir A, Shevchenko Tatiana V
Department of Hepatopancreatobiliary Surgery, The Vishnevsky Institute of Surgery, Moscow, Russia.
JOP. 2010 Jul 5;11(4):348-57.
It is important to recognize arterial variants in the preoperative planning of extended pancreatic resections. The absence of surgical confirmation of radiological data is a limitation of the majority of angiographic or CT-angiographic studies of celiac and mesenteric arterial anatomy.
The purpose of this study was to test the accuracy of CT angiography in delineating the arterial architecture by comparing the resultant 3D images with findings at surgery and determining the frequency of different celiac and mesenteric arterial anatomy variants.
Abdominal CT angiographies of 350 patients were performed on a 64- and 256-MDCT scanner prior to major pancreatic or hepatobiliary surgery. Variants of celiac and mesenteric arterial anatomy were documented as 3D reconstructions. Radiological data were compared to operative photographs during extended pancreaticoduodenectomies and extended distal pancreatectomies in 59 cases.
Only 197 patients (56.3%) had the classic arterial anatomy identified at CT angiography. The most common variants were a replaced or accessory right hepatic artery originating from the superior mesenteric artery (62 cases, 17.7%) and a replaced or accessory left hepatic artery (43 cases, 12.3%) originating from the left gastric artery. According to a comparison with operative photographs, CT angiography demonstrated 100% accuracy in identifying celiac and mesenteric arterial anatomy variants, stenoses, obstructions and aneurysms of the celiac and mesenteric branches, including those which were hemodynamically significant and which influence the choice and sequence of operative procedures.
The celiac and mesenteric arterial anatomy variants are fairly common and are of great significance in planning extended pancreatic resections. Radiological findings were fully corroborated by operative data, which means that CT angiography is a reliable tool for identifying celiac and mesenteric arterial anatomy aberrations and arterial lesions.
在扩大胰腺切除术的术前规划中识别动脉变异很重要。大多数关于腹腔干和肠系膜动脉解剖结构的血管造影或CT血管造影研究的一个局限性在于缺乏手术对放射学数据的确认。
本研究的目的是通过将所得的三维图像与手术结果进行比较，并确定不同腹腔干和肠系膜动脉解剖变异的频率，来测试CT血管造影在描绘动脉结构方面的准确性。
在进行大型胰腺或肝胆手术前，对350例患者在64层和256层MDCT扫描仪上进行腹部CT血管造影。将腹腔干和肠系膜动脉解剖变异记录为三维重建图像。在59例扩大胰十二指肠切除术和扩大远端胰腺切除术中，将放射学数据与手术照片进行比较。
在CT血管造影中，只有197例患者（56.3%）具有典型的动脉解剖结构。最常见的变异是起源于肠系膜上动脉的替代或副右肝动脉（62例，17.7%）和起源于胃左动脉的替代或副左肝动脉（43例，12.3%）。根据与手术照片的比较，CT血管造影在识别腹腔干和肠系膜动脉解剖变异、腹腔干和肠系膜分支的狭窄、阻塞和动脉瘤方面显示出100%的准确性，包括那些具有血流动力学意义且影响手术操作选择和顺序的病变。
腹腔干和肠系膜动脉解剖变异相当常见，在规划扩大胰腺切除术中具有重要意义。手术数据充分证实了放射学结果，这意味着CT血管造影是识别腹腔干和肠系膜动脉解剖异常及动脉病变的可靠工具。
