Department of Gastrointestinal Surgery, Vestfold Hospital, Tonsberg, Norway.
Dis Colon Rectum. 2011 Dec;54(12):1503-9. doi: 10.1097/DCR.0b013e318232116b.
Current practice when performing right colectomy for cancer is to divide the feeding vessels for the right colon on the right side of the superior mesenteric vein.
This study aims to show that arterial stumps can be visualized through an early postoperative CT and analyze their anatomical and surgical characteristics.
This study presents a retrospective review of prospective data.
:The study was conducted at the Department of Surgery, Vestfold Hospital, Tonsberg, Norway.
Patients with leakage after a right colectomy for cancer (2003-2011) were identified through a local prospective complication registry (FileMaker Pro 9.0v3 software).
Both preoperative and postoperative CTs were retrieved, reanalyzed, and 3-dimensionally reconstructed (Osirix v.3.0.2./Mimics v.13.1.). Patients without postoperative CTs were excluded.
The main outcomes measured were length, caliber of presumed and actual arterial stumps, and their position relative to the superior mesenteric vein.
Eighteen patients, median age 69 (10 men) were included. All patients had postoperative CTs, and 15 patients had preoperative CTs. Median time from operation to postoperative CT was 5 days. The ileocolic artery was found in 14 (11 CT pairs) patients, and the right colic artery was found in 5 (4 pairs) patients. Actual stump lengths were 28.0 mm (SD 9.3) and 37.3 mm (SD 14.9). A significant statistical difference between presumed and actual ileocolic artery stump lengths was found (P = .002). Posterior crossing to the superior mesenteric vein was noticed in 8 of 14 ileocolic arteries and in 3 of 5 right colic arteries. There was no statistical difference in mean caliber for the preoperative and postoperative right colic artery (P = .505) and ileocolic artery (P = .474).
Difficulties when interpreting the postoperative images, due to intra-abdominal effusion, staples, edema, and altered syntopy of blood vessels, were overcome through comparison with preoperative CTs.
An early postoperative CT can show arterial stumps after right colectomy for cancer. These stumps appear to be significantly longer than presumed; implying a significant improvement potential when specimen size is concerned.
目前行右半结肠癌根治术时，一般在肠系膜上静脉右侧离断右侧结肠的供血血管。
本研究旨在通过术后早期 CT 显示动脉残端，并分析其解剖和手术特点。
本研究为前瞻性数据的回顾性研究。
挪威滕斯贝格弗斯特尔医院外科。
通过当地前瞻性并发症登记处（FileMaker Pro 9.0v3 软件）确定 2003 年至 2011 年期间因右半结肠癌而行右半结肠切除术并发生吻合口漏的患者。
均行术前和术后 CT 检查，对其进行重新分析，并进行三维重建（Osirix v.3.0.2./Mimics v.13.1.）。排除无术后 CT 检查的患者。
主要观察指标为假定和实际动脉残端的长度、口径及其与肠系膜上静脉的相对位置。
18 例患者，中位年龄 69 岁（男 10 例），均行术后 CT 检查，其中 15 例行术前 CT 检查。术后至术后 CT 检查的中位时间为 5 天。14 例患者（11 对）发现回结肠动脉，5 例患者（4 对）发现右结肠动脉。实际残端长度为 28.0mm（SD 9.3）和 37.3mm（SD 14.9）。假定和实际回结肠动脉残端长度之间存在显著统计学差异（P =.002）。14 对回结肠动脉中有 8 对和 5 对右结肠动脉中有 3 对发现后交叉至肠系膜上静脉。术前和术后右结肠动脉（P =.505）和回结肠动脉（P =.474）的平均口径无统计学差异。
由于腹腔内积液、吻合钉、水肿和血管位置改变，在解释术后图像时存在困难，但通过与术前 CT 比较克服了这些困难。
右半结肠癌根治术后早期 CT 可显示动脉残端。这些残端看起来明显长于预期，这意味着在标本大小方面存在显著的改进潜力。
