双期 CT 对胃周血管解剖变异的分类，以减少腹腔镜胃切除术中的术中出血。
The classification of anatomic variations in the perigastric vessels by dual-phase CT to reduce intraoperative bleeding during laparoscopic gastrectomy.
机构信息
Department of Frontier Surgery, Chiba University Graduate School of Medicine, and Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan.
出版信息
Surg Endosc. 2011 May;25(5):1420-4. doi: 10.1007/s00464-010-1407-1. Epub 2010 Oct 26.
BACKGROUND
Laparoscopy-assisted distal gastrectomy (LADG) is a less invasive alternative compared with an open procedure. However, it is difficult to obtain a full-view image and to estimate the three-dimensional (3D) relationships between organs during laparoscopic procedures. Determining the vascular anatomy by 3D CT imaging has been shown to play a critical role in reducing the risks associated with laparoscopic gastric cancer surgery. The purpose of this study was to evaluate the clinical anatomic variations and to estimate its positive contribution in obtaining less intraoperative bleeding.
METHODS
Scanning was performed using a 64-row MDCT scanner. Three-dimensional CT images in the arterial and portal phase were reconstructed and fused together using the volume-rendering technique. The intraoperative bleeding findings were compared between two periods.
RESULTS
The anatomic variations of the celiac trunk were divided into six types. There were 159 patients with Adachi's type I, type II=8, type III=1, type IV=1, type V=2, type VI=3, and other=1. The inflows of the left gastric coronary vein (LCV) were divided into three types. The LCV flowed into the portal vein (PV) in 79 patients, into the splenic vein (SpV) in 65, and into the junction of these two veins in 27. The splenic artery was divided into flat type and curved type, and 65 cases (37%) showed the flat type. Intraoperative bleeding was significantly less between 2007 and 2008, in which the operations were performed without first making a 3D anatomy study, than in 2009, in which 3D anatomy studies were made and analyzed before surgery in all patients.
CONCLUSIONS
Dual-phase 3D CT is a useful and essential modality to visualize the precise anatomy around the stomach. As a result, by comparing 3D CT images with our classifications, it is believed that any surgeons may reduce the degree of intraoperative blood loss.
背景
与开放性手术相比，腹腔镜辅助远端胃切除术（LADG）是一种侵袭性较小的选择。然而，在腹腔镜手术中，很难获得全景图像并估计器官之间的三维（3D）关系。通过 3D CT 成像确定血管解剖结构已被证明在降低腹腔镜胃癌手术相关风险方面发挥着关键作用。本研究的目的是评估临床解剖变异，并估计其在减少术中出血方面的积极贡献。
方法
使用 64 排 MDCT 扫描仪进行扫描。使用容积再现技术对动脉期和门静脉期的三维 CT 图像进行重建和融合。比较了两个时期的术中出血情况。
结果
腹腔干的解剖变异分为六型。Adachi 型 I 有 159 例，II 型=8 例，III 型=1 例，IV 型=1 例，V 型=2 例，VI 型=3 例，其他=1 例。左胃冠状静脉（LCV）的流入分为三种类型。79 例 LCV 流入门静脉（PV），65 例流入脾静脉（SpV），27 例流入这两条静脉的交界处。脾动脉分为平型和曲型，65 例（37%）为平型。2007 年至 2008 年期间，在未进行 3D 解剖研究的情况下进行手术时，术中出血量明显少于 2009 年，在所有患者均进行 3D 解剖研究并在术前进行分析的情况下。
结论
双期 3D CT 是一种有用且必不可少的方法，可以精确显示胃周围的解剖结构。因此，通过将 3D CT 图像与我们的分类进行比较，可以认为任何外科医生都可以减少术中出血量。
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