Clinical Medical College of Jiangsu University, Department of General Surgery, Kunshan First People's Hospital Affiliated to Jiangsu University, Jiangsu Kunshan, 215300, China.
Department of General Surgery, First Hospital Affiliated to Soochow University, Suzhou Jiangsu, 215006, China.
Asian J Surg. 2020 Jan;43(1):9-12. doi: 10.1016/j.asjsur.2019.03.013. Epub 2019 Apr 10.
Laparoscopic complete mesocolic excision is gradually becoming the standard surgical approach in colon cancer therapy, the core element of which is central vascular ligation. However, this increases the difficulty for surgeons, particularly in the context of right colectomy, which encounters complex vascular anatomy. This study aimed to examine vascular variations that occur during laparoscopic right hemicolectomy through a review of the medical literature. We demonstrated that the ICA and MCA are evident in the majority of patients. The RCA was inconsistently present ranging from 12% to 45%. The ICA passed the SMV anteriorly or posteriorly at average rates. However, the RCA passed anterior to the SMV in most patients. Regarding intravenous, the ICV was consistently present, whereas the RCV was absent in up to 80% of patients. The GTH was present in nearly 80% of patients. We classified the vascular variations by the location of the branches instead of using numerical classification. The GCT and GPCT were common types whilst the GPT was relatively rare. In summary, detailed information on the vascular anatomical variations occurring on the right-side of the colon is vital. Failure to identify variations during surgical procedures can result in unwanted bleeding. Thus, we advocate for the use of the ICV as an anatomic marker during surgery.
腹腔镜完整结肠系膜切除术逐渐成为结肠癌治疗的标准手术方法，其核心要素是中央血管结扎。然而，这增加了外科医生的难度，特别是在右半结肠切除术的情况下，会遇到复杂的血管解剖结构。本研究旨在通过复习医学文献，检查腹腔镜右半结肠切除术过程中的血管变异情况。我们发现，ICA 和 MCA 在大多数患者中均存在。RCA 的存在率为 12%至 45%，不一致。ICA 平均从前或后通过 SMV。然而，大多数患者的 RCA 在前 SMV 通过。关于静脉，ICV 始终存在，而 RCV 在多达 80%的患者中不存在。GTH 几乎存在于 80%的患者中。我们根据分支的位置对血管变异进行分类，而不是使用数字分类。GCT 和 GPCT 是常见类型，而 GPT 相对较少。总之，详细了解结肠右侧发生的血管解剖变异至关重要。如果在手术过程中未能识别变异，可能会导致不必要的出血。因此，我们主张在手术中使用 ICV 作为解剖标志物。
