Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, 68 Zhongshan Road, Jiangsu, 214002, People's Republic of China.
Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, 68 Zhongshan Road, Jiangsu, 214002, People's Republic of China.
J Gastrointest Surg. 2020 Dec;24(12):2822-2828. doi: 10.1007/s11605-019-04460-1. Epub 2019 Dec 16.
To evaluate the clinical value of CT angiography (CTA), CT colonography (CTC), and image fusion in the preoperative evaluation of laparoscopic complete mesocolic excision (CME) for right colon cancer.
In this randomized prospective study, 80 patients undergoing laparoscopic CME for right colon cancer were randomly divided into two groups: image fusion [the original images were reconstructed using CTA and CTC, then fused into three-dimensional images of the blood vessels and intestines (n = 40)] and control (without CTA and CTC reconstruction before surgery). All patients underwent plain and enhanced abdominal CT before surgery.
In the image fusion group, the gastrocolic trunk of Henle was present in 33 cases, and its branches originated from the colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. Among these patients, 5 exhibited the right gastroepiploic vein and superior anterior pancreaticoduodenal vein; 21 exhibited a gastrointestinal trunk consisting of 2 or 3 branches of the right gastroepiploic vein, right colon vein, and middle colon vein; and 7 exhibited 3 or 4 gastro-pancreatic and colon trunks consisting of the right colon vein, middle colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. The correspondence with the anatomy actually observed during surgery was 100%. Compared with the conventional CT group, the duration of the operation in the image fusion group was shorter, with reduced intraoperative bleeding, and more lymph node dissection. There were no significant differences in the incidence of complications and length of hospital stay between the two groups (p > 0.05).
For laparoscopic CME for right colon cancer, CTA, CTC, and image fusion were effective preoperative evaluation methods, which avoided some unseen dangers in the operation process and led to better therapeutic outcomes.
评估 CT 血管造影（CTA）、CT 结肠成像（CTC）和图像融合在腹腔镜完整结肠系膜切除术（CME）治疗右半结肠癌术前评估中的临床价值。
在这项随机前瞻性研究中，80 例接受腹腔镜 CME 治疗的右半结肠癌患者被随机分为两组：图像融合组（原始图像使用 CTA 和 CTC 重建，然后融合为血管和肠道的三维图像（n=40））和对照组（手术前不进行 CTA 和 CTC 重建）。所有患者术前均行腹部平扫及增强 CT 检查。
在图像融合组中，33 例可见胃结肠干，其分支起源于结肠静脉、胃网膜右静脉和胰十二指肠上前静脉。其中，5 例显示胃网膜右静脉和胰十二指肠上前静脉；21 例显示由胃网膜右静脉、右结肠静脉和中结肠静脉的 2 或 3 个分支组成的胃肠道干；7 例显示由右结肠静脉、中结肠静脉、胃网膜右静脉和胰十二指肠上前静脉组成的 3 或 4 个胃-胰-结肠干。与手术中实际观察到的解剖结构完全吻合。与常规 CT 组相比，图像融合组的手术时间更短，术中出血量减少，淋巴结清扫更多。两组并发症发生率和住院时间无显著差异（p>0.05）。
对于腹腔镜 CME 治疗右半结肠癌，CTA、CTC 和图像融合是有效的术前评估方法，可以避免手术过程中的一些潜在危险，从而获得更好的治疗效果。
