Yamashita Keishi, Sakuramoto Shinichi, Mieno Hiroaki, Shibata Tomotaka, Nemoto Masayuki, Katada Natsuya, Kikuchi Shiro, Watanabe Masahiko
Department of Surgery, Kitasato University School of Medicine, Asamizodai 2-1-1, Minami-ku, Sagamihara, Kanagawa, 252-0380, Japan,
Surg Today. 2014 Oct;44(10):1912-9. doi: 10.1007/s00595-014-0858-8. Epub 2014 Feb 13.
In the current study, we evaluated the efficacy of dual-phase three-dimensional (3D) CT angiography (CTA) in the assessment of the vascular anatomy, especially the right hepatic artery (RHA), before gastrectomy.
The study initially included 714 consecutive patients being treated for gastric cancer. A dual-phase contrast-enhanced CT scan using 32-multi detector-row CT was performed for all patients.
Among the 714 patients, 3D CTA clearly identified anomalies with the RHA arising from the superior mesenteric artery (SMA) in 49 cases (6.9 %). In Michels' classification type IX, the common hepatic artery (CHA) originates only from the SMA. Such cases exhibit defective anatomy for the CHA in conjunction with the celiac-splenic artery system, resulting in direct exposure of the portal vein beneath the #8a lymph node station, which was retrospectively confirmed by video in laparoscopic gastrectomy cases. Fused images of both 3D angiography and venography were obtained, and could have predicted the risk preoperatively, and the surgical finding confirmed its usefulness.
Preoperative evaluations using 3D CTA can provide more accurate information about the vessel anatomy. The fused images from 3D CTA have the potential to reduce the intraoperative risks for injuries to critical vessel, such as the portal vein, during gastrectomy.
在本研究中，我们评估了双期三维（3D）CT血管造影（CTA）在胃癌根治术前评估血管解剖结构，尤其是肝右动脉（RHA）方面的有效性。
该研究最初纳入了714例连续接受胃癌治疗的患者。对所有患者均使用32排多层螺旋CT进行双期对比增强CT扫描。
在这714例患者中，3D CTA清晰地识别出49例（6.9%）肝右动脉发自肠系膜上动脉（SMA）的异常情况。在米歇尔分类IX型中，肝总动脉（CHA）仅起源于SMA。此类病例显示出CHA与腹腔干-脾动脉系统的解剖结构存在缺陷，导致#8a淋巴结站下方的门静脉直接暴露，这在腹腔镜胃癌根治术病例中通过视频回顾得到了证实。获得了3D血管造影和静脉造影的融合图像，术前能够预测风险，手术结果证实了其有用性。
使用3D CTA进行术前评估可以提供更准确的血管解剖信息。3D CTA的融合图像有可能降低胃癌根治术中门静脉等关键血管损伤的术中风险。
