Murono Koji, Kawai Kazushige, Ishihara Soichiro, Otani Kensuke, Yasuda Koji, Nishikawa Takeshi, Tanaka Toshiaki, Kiyomatsu Tomomichi, Hata Keisuke, Nozawa Hiroaki, Yamaguchi Hironori, Watanabe Toshiaki
Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Int J Colorectal Dis. 2016 Sep;31(9):1633-8. doi: 10.1007/s00384-016-2627-1. Epub 2016 Jul 27.
The requisite for a rigorous preoperative understanding of vascular branching continues to grow in parallel with the implementation of laparoscopic surgery. Three-dimensional (3D)-computed tomography (CT) angiography is a less-invasive modality than traditional angiographic examination. Therefore, we aimed to evaluate branching patterns of the superior mesenteric artery (SMA).
In the present study, 536 consecutive patients who underwent preoperative 3D-CT angiography from April 2012 to March 2014 were prospectively enrolled. The branching pattern of the right colic artery (RCA) and the intersectional patterns of the RCA, ileocolic artery (ICA), and superior mesenteric vein (SMV) were evaluated.
The RCA existed in only 179 cases (33.4 %); the remaining 357 patients (66.6 %) lacked evidence of the RCA. The ICA was detected in all cases. The RCA ran ventral to the SMV in the majority of cases (89.4 %). Conversely, the ICA ran ventral to the SMV in only half of the cases (50.6 %). When the RCA was observed to pass dorsal to the SMV, the ICA also ran dorsal to SMV in all cases.
3D-CT angiography can aid surgeons in identifying and understanding the anatomical vascular variations and intersectional patterns of the RCA, ICA, and SMV. Developing awareness of these variations can aid in the prevention of unexpected vascular injury during laparoscopic right-sided colon surgery.
随着腹腔镜手术的开展，术前对血管分支进行严谨评估的需求持续增加。三维（3D）计算机断层扫描（CT）血管造影术是一种比传统血管造影检查侵入性更小的检查方式。因此，我们旨在评估肠系膜上动脉（SMA）的分支模式。
在本研究中，前瞻性纳入了2012年4月至2014年3月期间连续536例行术前3D-CT血管造影的患者。评估了右结肠动脉（RCA）的分支模式以及RCA、回结肠动脉（ICA）和肠系膜上静脉（SMV）的交叉模式。
仅179例（33.4%）存在RCA；其余357例患者（66.6%）未发现RCA。所有病例均检测到ICA。在大多数情况下（89.4%），RCA走行于SMV腹侧。相反，仅半数病例（50.6%）中ICA走行于SMV腹侧。当观察到RCA走行于SMV背侧时，所有病例中ICA也走行于SMV背侧。
3D-CT血管造影术可帮助外科医生识别和了解RCA、ICA和SMV的解剖血管变异及交叉模式。认识这些变异有助于预防腹腔镜右侧结肠手术期间意外的血管损伤。
