Stimec Bojan V, Andersen Bjarte T, Benz Stefan R, Fasel Jean H D, Augestad Knut M, Ignjatovic Dejan
Anatomy Sector, Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland.
Department of Digestive Surgery, Østfold Hospital, Fredrikstad, Norway.
Int J Colorectal Dis. 2018 Jun;33(6):771-777. doi: 10.1007/s00384-018-2987-9. Epub 2018 Feb 22.
The middle colic artery (MCA) is of crucial importance in abdominal surgery, for laparoscopic or open right and transverse colectomies. Against this background, a high number of reports concerning anatomical variations of the MCA have been published intended to contribute to the improvement of operative techniques for the treatment of colon cancer. Despite this extensive literature, briefly reviewed in the present paper, a course of the MCA posterior to the superior mesenteric vein, called a retromesenteric trajectory, has been related to only once, to the best of our knowledge.
A total series of 507 patients included in two prospective trials concerning laparoscopic or open right colectomy for cancer between 2011 and 2017 are reported. The investigation included preoperative or postoperative multidetector-computed tomography angiography.
We found four (0.79%) cases of retromesenteric MCA. They all underwent meticulous image analysis with mesenteric vessels' road mapping, detailed morphometry, and surgical validation which revealed that, apart from their course, those cases did not differ significantly from the rest of the series.
This paper therefore documents the worth-knowing behavior causing considerable confusion for the operating surgeon unaware of the abnormality and shows its concrete impact on patient-tailored surgical practice, in particular for laparoscopic D3 colectomy (including the "uncinated process first" approach).
在腹部手术中，对于腹腔镜或开放的右半结肠和横结肠切除术而言，中结肠动脉（MCA）至关重要。在此背景下，大量关于MCA解剖变异的报告已发表，旨在有助于改进结肠癌的手术技术。尽管有大量此类文献，本文对此进行了简要回顾，但据我们所知，肠系膜上静脉后方的MCA走行，即所谓的肠系膜后走行，仅被提及过一次。
报告了2011年至2017年间纳入两项关于腹腔镜或开放右半结肠癌切除术的前瞻性试验的507例患者。调查包括术前或术后的多排螺旋计算机断层血管造影。
我们发现4例（0.79%）肠系膜后MCA病例。对这些病例均进行了细致的图像分析，包括肠系膜血管路径图绘制、详细的形态测量以及手术验证，结果显示，除走行外，这些病例与该系列的其他病例并无显著差异。
因此，本文记录了这种值得了解的情况，它会给未意识到该异常的手术医生造成相当大的困扰，并展示了其对个体化手术实践的具体影响，特别是对于腹腔镜D3结肠切除术（包括“先行钩突”入路）。
