Anatomy Sector, Teaching Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway.
Colorectal Dis. 2020 Dec;22(12):1949-1957. doi: 10.1111/codi.15284. Epub 2020 Aug 17.
The ileocolic vessels are important landmarks in advanced surgery of the midgut. The aim of the present study is to present variations of ileocolic vessels relevant to complete mesocolic excision with D3 lymphadenectomy of the right colon, within their detailed and precise morphometric framework and deriving from a large and consistent series of operated patients.
An ongoing prospective trial 'Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multidetector Computed Tomography Angiography' was reviewed. The imaging datasets underwent manual segmentation and 3D reconstruction, and the results were validated at surgery. A total of 356 patients were included in the study.
A cross-section of the series revealed five cases (1.4%) with variation of ileocolic vessels relevant to complete mesocolic excision or D3 extended mesenterectomy. There were two cases with absence of a true classical ileocolic artery, two cases with absence of a true classical ileocolic vein, and one case of precocious bifurcation of the ileocolic artery, left to the superior mesenteric vein. The entire D3 area in all the cases was thoroughly documented and analysed from the morphometric point of view (calibres, lengths of vessels, crossing patterns).
The preoperative visualization of a patient's individual 3D anatomy is a powerful tool in identifying the variations whose negligence could have dire consequences in complete mesocolic excision of the right colon.
回结肠血管是中肠外科手术的重要标志。本研究旨在通过术前双相多层螺旋 CT 血管造影，为右半结肠癌 D3 淋巴结清扫术提供完整结肠系膜切除术相关的回结肠血管的详细、精确的形态学框架内的变异，并从大量连续手术患者中得出结论。
回顾性分析一项正在进行的前瞻性试验“通过术前双相多排 CT 血管造影安全行根治性 D3 右半结肠切除术治疗癌症”。对影像学数据集进行手动分割和 3D 重建，并在手术中进行验证。共有 356 例患者纳入本研究。
对系列的横断面显示，有 5 例（1.4%）存在与完整结肠系膜切除术或 D3 扩大肠系膜切除术相关的回结肠血管变异。有 2 例存在真正的经典回结肠动脉缺失，2 例存在真正的经典回结肠静脉缺失，1 例回结肠动脉过早分支，位于肠系膜上静脉左侧。从形态学角度（口径、血管长度、交叉模式）彻底记录和分析了所有病例的整个 D3 区域。
术前可视化患者的个体 3D 解剖结构是识别变异的有力工具，如果忽视这些变异，可能会对右半结肠癌完整结肠系膜切除术产生严重后果。
