Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, 327, Sosa-ro, Bucheon-si, Gyeonggi-do, South Korea.
Surg Endosc. 2019 Jun;33(6):1903-1909. doi: 10.1007/s00464-018-6470-z. Epub 2018 Sep 26.
Surgeons normally encounter the left gastric vein (LGV) during laparoscopic gastrectomy (LG) for gastric cancer, and the various anatomic variants of this vessel make the procedure difficult. The objective of this study was to classify anatomic variants of the LGV in the laparoscopic operation field and clarify their clinical significance during LG.
In total, 405 patients who underwent LG in 2013-2017 for gastric cancer were enrolled in the study. LGV drainage was classified into six types by the anatomic relation of the LGV to the arteries of the celiac axis: Type Ia [LGV runs anteriorly to the common hepatic artery (CHA)], Type Ip (LGV runs posteriorly to CHA), Type II (LGV runs anteriorly to the left gastric artery), Type IIIa [LGV runs anteriorly to the splenic artery (SA)], Type IIIp (LGV runs posteriorly to SA), and Type IV (LGV runs cranially into the proximal portal vein or liver parenchyma). If the LGV was injured during the operation, the patient was included as a member of the injury group (IG).
Most patients (n = 391, 96.5%) had a single LGV, whereas 14 (3.5%) patients had double LGVs. Type Ip was the most common of the six drainage types (n = 195, 48.1%). The number of patients in the IG was 49 (13.0%). Types I and III were relatively easily injured when compared with type II (p = 0.025). Patients in the IG had longer operation times, more blood loss, and more lymph node metastases than the non-IG patients.
In most patients, the LGV drains posteriorly to the CHA or anteriorly to the LGA. Gastric surgeons should take great care not to injure the LGV during LG when it is not present on the anterior side of the celiac axis.
外科医生在腹腔镜胃癌手术（LG）中通常会遇到胃左静脉（LGV），而该血管的各种解剖变异使得手术变得困难。本研究的目的是在腹腔镜手术视野中对 LGV 的解剖变异进行分类，并阐明其在 LG 过程中的临床意义。
共纳入 2013 年至 2017 年间因胃癌行 LG 的 405 例患者。根据 LGV 与腹腔干动脉的解剖关系，将 LGV 引流分为六型：Ia 型[LGV 位于肝总动脉（CHA）前方]、Ip 型[LGV 位于 CHA 后方]、II 型[LGV 位于胃左动脉前方]、IIIa 型[LGV 位于脾动脉（SA）前方]、IIIp 型[LGV 位于 SA 后方]和 IV 型[LGV 向近端门静脉或肝实质内走行]。如果在手术中 LGV 受损，则将患者纳入损伤组（IG）。
大多数患者（n=391，96.5%）仅有一条 LGV，而 14 例（3.5%）患者有两条 LGV。六种引流类型中，Ip 型最为常见（n=195，48.1%）。IG 患者 49 例（13.0%）。与 II 型相比，I 型和 III 型相对容易受损（p=0.025）。IG 患者的手术时间更长，出血量更多，淋巴结转移更多。
在大多数患者中，LGV 向后引流至 CHA 或向前引流至 LGA。胃外科医生在 LG 时应特别注意不要损伤不在腹腔干前方的 LGV。
