Lee Sang Jae, Park Sung Chan, Kim Min Jung, Sohn Dae Kyung, Oh Jae Hwan
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
Dis Colon Rectum. 2016 Aug;59(8):718-24. doi: 10.1097/DCR.0000000000000636.
The vascular anatomy in the right colon varies; however, related studies are rare, especially on the laparoscopic vascular anatomy of living patients.
The purpose of this study was to describe vascular variations around the gastrocolic trunk, middle colic vein, and ileocolic vessels in laparoscopic surgery for right-sided colon cancer.
This is a retrospective descriptive study of patients undergoing laparoscopic colectomy for right colon cancer.
The study was conducted at a single tertiary institution in Korea.
Consecutive patients with right colon cancer who underwent laparoscopic right colectomy using the cranial-to-caudal approach (N = 116) between January 2014 and April 2015 were included.
Three colorectal surgeons took photographs and videos of the vascular anatomy during each laparoscopic right colectomy, and these were analyzed for vascular variations.
We classified venous variations around the gastrocolic trunk into 2 types (3 subtypes), type 1 (n = 92 (79.3%)), defined as 1 or 2 colic veins draining into the gastrocolic trunk, and type II (n = 24 (20.7%)), defined as having no gastrocolic trunk. We also investigated the tributaries of the superior mesenteric vein. One, 2, and 3 middle colic veins were found in 86 (74.1%), 26 (22.4%), and 4 patients (3.5%). The right colic vein drained directly into the superior mesenteric vein in 22 patients (19.0%). All of the patients had a single ileocolic vein draining into the superior mesenteric vein and a single ileocolic artery from the superior mesenteric artery. The right colic artery from the superior mesenteric artery was present in 38 patients (32.7%). The ileocolic artery passed the superior mesenteric vein anteriorly or posteriorly in 58 patients (50%) each.
Unlike cadaver or radiological studies, we could not clarify the complete vessel paths.
We classified vascular anatomic variations in laparoscopic colectomy for right colon cancer, which could be helpful for colorectal surgeons.
右半结肠的血管解剖结构存在差异；然而，相关研究较少，尤其是关于活体患者的腹腔镜血管解剖。
本研究旨在描述腹腔镜下右半结肠癌手术中胃结肠干、结肠中静脉和回结肠血管周围的血管变异情况。
这是一项对接受腹腔镜右半结肠切除术患者的回顾性描述性研究。
该研究在韩国一家三级医疗机构进行。
纳入2014年1月至2015年4月期间采用头端至尾端入路接受腹腔镜右半结肠切除术的连续性右半结肠癌患者（N = 116）。
三名结直肠外科医生在每次腹腔镜右半结肠切除术中拍摄血管解剖结构的照片和视频，并对这些资料进行血管变异分析。
我们将胃结肠干周围的静脉变异分为2种类型（3个亚型），1型（n = 92（79.3%）），定义为1条或2条结肠静脉汇入胃结肠干；2型（n = 24（20.7%）），定义为无胃结肠干。我们还研究了肠系膜上静脉的属支。发现1条、2条和3条结肠中静脉的患者分别有86例（74.1%）、26例（22.4%）和4例（3.5%）。22例患者（19.0%）的右结肠静脉直接汇入肠系膜上静脉。所有患者均有1条回结肠静脉汇入肠系膜上静脉，且有1条来自肠系膜上动脉的回结肠动脉。38例患者（32.7%）有来自肠系膜上动脉的右结肠动脉。回结肠动脉分别有58例患者（50%）从肠系膜上静脉前方或后方经过。
与尸体或放射学研究不同，我们无法明确完整的血管走行。
我们对腹腔镜右半结肠切除术的血管解剖变异进行了分类，这可能对结直肠外科医生有所帮助。
