Narushima Kazuo, Hirano Atsushi, Mori Mikito, Yoshida Masahiro, Ohira Gaku, Miyauchi Hideaki, Matsubara Hisahiro, Shuto Kiyohiko
Dept. of Surgery, International University of Health and Welfare Ichikawa Hospital.
Gan To Kagaku Ryoho. 2021 Mar;48(3):428-430.
Simulation computed tomography colonography(sCTC), which combines CTC and 3-dimensional vascular imaging, is popular for the surgery of colorectal cancer. We experience anomaly, called arc of Riolan(aR), rarely but its definition and details are unclear. Using sCTC, we identified aR and investigated the simulation of aR-conserving high ligation.
The patients were 3 cases of sigmoid colorectal cancer with aR in 369 patients who underwent sCTC before colorectal cancer surgery. We identified the running morphology of aR. And we classified Griffiths' point as presence(P)and absence(A). Narrow or mesh-shaped artery which were ischemic risk factors of intestinal tract was P groups and normal artery was A groups in the marginal artery of splenic flexure. We simulated aR-conserving lymph node dissection using sCTC.
Case 1. The patient was 60-year-old man with rectal cancer, cT4aN1M0, Stage Ⅲa. The running morphology of aR was between the left branch of middle colic artery(MCA lt)and LCA. Griffiths point: P. Surgical simulation was D3 lymph node dissection with preservation of aR and high ligation of IMA. Pathological findings was pT3N1M0, Stage Ⅲa. Case 2. The patient was 65-year-old woman with sigmoid colon cancer, cT3N2M0, Stage Ⅲb. The running morphology of aR was between MCA lt and IMA. Griffiths point: P. Surgical simulation was D3 lymph node dissection with preservation of aR and high ligation of IMA. Pathological findings was pT3N2M0, Stage Ⅲb. Case 3. The patient was 75-year-old woman with sigmoid colon cancer, cT1bN0M0, Stage Ⅰ. The running morphology of aR was between first jejunal artery and IMA. Griffiths point: A. Surgical simulation was D3 lymph node dissection with preservation of aR and high ligation of IMA. Pathological findings was pT1bN0M0, Stage Ⅲb.
Using sCTC, we could identify the various running morphology of aR and simulate aR-conserving lymph node dissection in high ligation.
模拟计算机断层扫描结肠成像（sCTC）结合了CT结肠成像（CTC）和三维血管成像，在结直肠癌手术中应用广泛。我们偶尔会遇到一种名为Riolan弓（aR）的异常情况，但其定义和细节尚不清楚。利用sCTC，我们识别出了aR，并研究了保留aR的高位结扎模拟情况。
在369例接受结直肠癌手术前sCTC检查的患者中，有3例乙状结肠直肠癌患者存在aR。我们确定了aR的走行形态。并且我们将格里菲斯点分为存在（P）和不存在（A）。在脾曲边缘动脉中，狭窄或网状动脉是肠道缺血危险因素，为P组，正常动脉为A组。我们使用sCTC模拟保留aR的淋巴结清扫。
病例1。患者为60岁男性，患有直肠癌，cT4aN1M0，Ⅲa期。aR的走行形态位于中结肠动脉左支（MCA lt）和左结肠动脉（LCA）之间。格里菲斯点：P。手术模拟为保留aR并高位结扎肠系膜下动脉（IMA）的D3淋巴结清扫。病理结果为pT3N1M0，Ⅲa期。病例2。患者为65岁女性，患有乙状结肠癌，cT3N2M0，Ⅲb期。aR的走行形态位于MCA lt和IMA之间。格里菲斯点：P。手术模拟为保留aR并高位结扎IMA的D3淋巴结清扫。病理结果为pT3N2M0，Ⅲb期。病例3。患者为75岁女性，患有乙状结肠癌，cT1bN0M0，Ⅰ期。aR的走行形态位于空肠第一动脉和IMA之间。格里菲斯点：A。手术模拟为保留aR并高位结扎IMA的D3淋巴结清扫。病理结果为pT1bN0M0，Ⅲb期。
利用sCTC，我们能够识别aR的各种走行形态，并模拟保留aR的高位结扎淋巴结清扫。
