Nesgaard J M, Stimec B V, Bakka A O, Edwin B, Ignjatovic D
Department of Gastrointestinal Surgery, Vestfold Hospital, Tonsberg, Norway.
Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland.
Colorectal Dis. 2017 Jul;19(7):656-666. doi: 10.1111/codi.13592.
Vascular abnormalities present advantages and/or disadvantages for the patient undergoing surgery. The aims of this study were to define, classify and demonstrate the courses, and to assess the clinical value, of arterial and venous abnormalities in the central mesentery.
We conducted a review of the anatomy of 340 patients planned for enrolment in the 'Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic MDCT Angiography' trial, 312 of whom were submitted to surgery. Vascular abnormalities were analysed in context with surgical notes and images. A meta-analysis of the literature was performed.
Arterial Abnormalities were found in 28 (8.2%) of the 340 patients and were classified into the following three groups based on anticipated surgical difficulty: group 1, accessory or replaced arteries to solid organs [14 (4.1%)]; group 2, arterial shunts [11 (3.2%)] between the coeliac trunk and the superior mesenteric artery, which resulted in bleeding in three patients; and group 3, common stem abnormalities [3 (0.9%)]. Two groups of superior mesenteric vein abnormalities were noted. The first included morphological abnormalities in a single vein [4 (1.2%)]: aneurysm [1 (0.3%)]; and ring variants of principal tributaries [3 (0.9%)]. The second included double superior mesenteric vein trunks [31 (9.1%)]: genuine bifid [10 (2.9%)]; and pseudo bifid [21 (6.2%)]. The meta-analysis revealed 26 articles, including 10 series of anatomical dissections or angiographies [1970 cases with 205 (10.4%) arterial abnormalities] and 16 case reports, none of which described a clinical or surgical setting.
Vascular abnormalities occur frequently. Arterial abnormalities are a hazard when inadvertent injury occurs during surgery. Preoperative knowledge of a bifid superior mesenteric vein is useful.
血管异常对于接受手术的患者存在优势和/或劣势。本研究的目的是明确、分类并展示中央肠系膜动脉和静脉异常的走行，并评估其临床价值。
我们回顾了计划纳入“通过术前双期MDCT血管造影进行安全的根治性D3右半结肠切除术治疗癌症”试验的340例患者的解剖结构，其中312例接受了手术。结合手术记录和图像分析血管异常情况。对文献进行了荟萃分析。
在340例患者中，有28例（8.2%）发现动脉异常，根据预期手术难度分为以下三组：第1组，供应实体器官的副动脉或替代动脉[14例（4.1%）]；第2组，腹腔干与肠系膜上动脉之间的动脉分流[11例（3.2%）]，其中3例患者出现出血；第3组，共同干异常[3例（0.9%）]。发现了两组肠系膜上静脉异常。第一组包括单一静脉的形态异常[4例（1.2%）]：动脉瘤[1例（0.3%）]；主要分支的环状变异[3例（0.9%）]。第二组包括双肠系膜上静脉干[31例（9.1%）]：真性双干[10例（2.9%）]；假性双干[21例（6.2%）]。荟萃分析显示有26篇文章，包括10组解剖解剖或血管造影[1970例中有205例（10.4%）动脉异常]和16例病例报告，均未描述临床或手术情况。
血管异常经常发生。手术中意外损伤时，动脉异常是一种危险因素。术前了解双肠系膜上静脉是有用的。
