Feng Bo, Yan Xialin, Zhang Sen, Xue Pei, He Zirui, Zheng Minhua
Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Minimally Invasive Surgery Clinical Medical Center, Shanghai 200025, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Jun 25;20(6):635-638.
The advancement of laparoscopic surgery serves as a trigger for better understanding of the vascular structure at the inferior border of the pancreas, especially Henle trunk. Henle trunk was first found as convergence to superior mesenteric vein (SMV) conjoined by sub-right colon vein (SRCV) and right gastroepiploic vein (RGEV), but decades later, anterior superior pancreatic duodenal vein (ASPDV) was described as another conjoint vein of Henle trunk. These tributaries are the basic elements of Henle trunk in early years' study. A proper surgical procedure for Henle trunk can significantly reduce the complications of radical right hemi-colectomy (Japanese D3 resection and European complete mesocolic excision, CME). There are four variations of Henle trunk according to the colic venous tributaries that consists the anatomic variations in transverse colon posterior space(TRCPS). These variations are like "fingerprint and pattern" of CME. The recognition and extension of the TRCS is the key to the dissection of Henle trunk in laparoscopic right hemi-colectomy. Our medical center proposed four feasible approaches for extension:(1) hybrid medial approach; (2) completely medial approach; (3)completely medial access by "page-turning" approach; (4) completely medial approach along RCV. Mostly, RCV ended in Henle trunk, and completely medial approach along RCV is efficient to identify the Henle trunk in CME. We suggest dissecting the inferior margin of pancreas along SMV in a bottom-to-top fashion, followed by the dissection of middle colic vessels to reveal the root of Henle trunk. And it's better to dissect Henle trunk by branch rather than at its root for safety. Here, we describe the anatomic characters of Henles trunk, the surgical approach and strategies of Henle trunk in laparoscopic surgery.
腹腔镜手术的发展促使人们更好地了解胰腺下缘的血管结构，尤其是亨勒干。亨勒干最初被发现是由右结肠下静脉（SRCV）和右胃网膜静脉（RGEV）汇合至肠系膜上静脉（SMV），但几十年后，胰十二指肠上前静脉（ASPDV）被描述为亨勒干的另一条汇合静脉。这些属支是早年研究中亨勒干的基本组成部分。针对亨勒干采取恰当的手术操作可显著降低根治性右半结肠切除术（日本D3切除和欧洲完整结肠系膜切除术，CME）的并发症。根据构成横结肠后间隙（TRCPS）解剖变异的结肠静脉属支，亨勒干有四种变异。这些变异就如同CME的“指纹和图案”。TRCS的识别与扩展是腹腔镜右半结肠切除术中解剖亨勒干的关键。我们的医学中心提出了四种可行的扩展方法：（1）混合内侧入路；（2）完全内侧入路；（3）“翻书页”式完全内侧入路；（4）沿右结肠静脉（RCV）的完全内侧入路。多数情况下，RCV汇入亨勒干，沿RCV的完全内侧入路在CME中能有效地识别亨勒干。我们建议自下而上沿SMV解剖胰腺下缘，随后解剖中结肠血管以显露亨勒干根部。为安全起见，最好按分支而非根部解剖亨勒干。在此，我们描述亨勒干的解剖特征、腹腔镜手术中亨勒干手术入路及策略。
