Alsabilah Jamal F, Razvi Syed A, Albandar Mahdi H, Kim Nam K
Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, Korea.
Dis Colon Rectum. 2017 Jan;60(1):22-29. doi: 10.1097/DCR.0000000000000720.
Vascular supply to the right colon has become an issue because of high variability and subsequent impact on minimally invasive surgery. Past cadaveric or radiologic anatomic assessments are noncomprehensive.
Intraoperative charting of right colonic arteriovenous anatomy was undertaken to determine the incidence and scope of vascular variations.
Vascular anatomy variations were documented in snapshot images, captured during laparoscopic video recordings or through open surgical digital photography.
Data were drawn from consecutive right hemicolectomies, routinely entailing complete mesocolic excision with central vascular ligation.
Seventy patients (mean age, 62.7 years; 37 women (52.8%); 33 men (47.2%)), each with surgically treatable right-sided colon cancer, were prospectively studied.
Both ileocolic and middle colic arteries were regularly identified (100%), with right colic artery present in 41.4% of patients. Ileocolic and middle colic veins consistently drained into the right colon. Although the ileocolic vein always emptied into the superior mesenteric vein, drainage of the middle colic vein was split (superior mesenteric vein, 94.3%; gastrocolic trunk of Henle, 5.3%), as was drainage of the right colic (superior mesenteric vein, 43.3%; gastrocolic trunk of Henle, 56.7%) and accessory middle colic veins (superior mesenteric vein, 54.5%; gastrocolic trunk of Henle, 45.5%), present in 42.9% and 15.7% of patients. Gastrocolic trunk of Henle was found in 88.6% of patients, usually draining into the superior mesenteric vein. No significant sex-related differences were present regarding the incidence and scope of variability displayed by the right colic artery, right colic vein, accessory middle colic vein, or gastrocolic trunk of Henle classification (p > 0.05).
The inconsistency between cadaver and live surgery anatomy and the low BMI of the Asian population might be drawbacks of our study.
Variations in right colonic arteriovenous channels, assessed intraoperatively, corroborate those established by cadaveric and radiologic means, prompting a new gastrocolic trunk of Henle classification.
由于右半结肠血管供应的高度变异性及其对微创手术的后续影响，其血管供应已成为一个问题。以往的尸体解剖或放射学解剖评估并不全面。
对右半结肠动静脉解剖结构进行术中绘图，以确定血管变异的发生率和范围。
血管解剖变异通过腹腔镜视频记录或开放手术数码摄影过程中抓拍的快照图像进行记录。
数据来自连续的右半结肠切除术，常规包括完整的结肠系膜切除及中央血管结扎。
前瞻性研究了70例患者（平均年龄62.7岁；女性37例（52.8%）；男性33例（47.2%）），均患有可手术治疗的右侧结肠癌。
回结肠动脉和中结肠动脉均能常规识别（100%），41.4%的患者存在右结肠动脉。回结肠静脉和中结肠静脉持续引流至右半结肠。虽然回结肠静脉总是汇入肠系膜上静脉，但中结肠静脉的引流存在分歧（肠系膜上静脉，94.3%；亨氏胃结肠干，5.3%），右结肠静脉（肠系膜上静脉，43.3%；亨氏胃结肠干，56.7%）和副中结肠静脉（肠系膜上静脉，54.5%；亨氏胃结肠干，45.5%）的引流情况也是如此，分别见于42.9%和15.7% 的患者。88.6%的患者发现有亨氏胃结肠干，通常汇入肠系膜上静脉。右结肠动脉、右结肠静脉、副中结肠静脉或亨氏胃结肠干分类所显示的变异发生率和范围在性别上无显著差异（p>0.05）。
尸体解剖与活体手术解剖之间的不一致以及亚洲人群较低的体重指数可能是本研究的缺点。
术中评估的右半结肠动静脉通道变异与尸体解剖和放射学方法所确定的变异相符，促使提出新的亨氏胃结肠干分类。
