应用增强多排螺旋 CT 对胃周血管的三维解剖结构进行全面评估。
Comprehensive evaluation of three-dimensional anatomy of perigastric vessels using enhanced multidetector-row computed tomography.
机构信息
Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550, Japan.
Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
出版信息
BMC Surg. 2022 Nov 21;22(1):403. doi: 10.1186/s12893-022-01836-0.
BACKGROUND
To perform laparoscopic gastrectomy safely, we aimed to comprehensively re-evaluate perigastric vessel anatomies using a three-dimensional angiography reconstructed from enhanced multidetector-row computed tomography data.
METHODS
Perigastric vessel anatomy was preoperatively analyzed using a multidetector-row computed tomography-based three-dimensional angiography reconstructed in 127 patients undergoing gastric surgery.
RESULTS
Of the 67 left gastric veins that ran along the dorsal side of the arteries, 59 (88.1%) ran along the dorsal side of the common hepatic artery and flowed into the portal vein. In 18 cases, a common trunk of one to three left gastric arteries and the replaced left hepatic artery was observed. The left inferior phrenic artery ramified from the left gastric artery in 5.5% of the cases. The right gastric artery was classified into distal (73.2%), caudal (18.1%), and proximal (8.7%) types. The infra-pyloric artery was also classified into distal (64.6%), caudal (26.0%), and proximal (9.4%) types. The posterior gastric artery branched as a common trunk with the superior polar artery in the proximal (37.9%) and distal (18.4%) regions of the splenic artery. The left gastroepiploic artery ramified from the splenic (18.1%) and inferior terminal arteries (81.9%). No, one, and two gastric branches of the left gastroepiploic artery, which ramified between the roots of the left gastroepiploic artery and its omental branch, were found in 36.5%, 49.2%, and 14.3% of the cases, respectively.
CONCLUSIONS
Preoperative 3D angiography is useful for the precise evaluation of perigastric vessel anatomies, and may help us to perform laparoscopic gastrectomy and robotic surgery safely.
背景
为了安全地进行腹腔镜胃切除术，我们旨在通过使用从增强型多排计算机断层扫描数据重建的三维血管造影术来全面重新评估胃周血管解剖结构。
方法
对 127 例接受胃手术的患者，使用基于多排计算机断层扫描的三维血管造影术在术前分析胃周血管解剖结构。
结果
67 条沿动脉背侧走行的胃左静脉中，59 条（88.1%）沿肝总动脉背侧走行并流入门静脉。在 18 例中，观察到一条至三条胃左动脉和替代左肝动脉的共同干。左膈下动脉在 5.5%的病例中从胃左动脉分出。胃右动脉分为远端（73.2%）、尾侧（18.1%）和近端（8.7%）型。胃下动脉也分为远端（64.6%）、尾侧（26.0%）和近端（9.4%）型。胃后动脉在脾动脉的近端（37.9%）和远端（18.4%）区与上极动脉分支为共同干。胃网膜左动脉从脾动脉（18.1%）和下终动脉（81.9%）分支。在 36.5%、49.2%和 14.3%的病例中，分别发现 1 支、2 支和 3 支胃网膜左动脉分支在胃网膜左动脉根部与其网膜支之间分支。
结论
术前 3D 血管造影术有助于准确评估胃周血管解剖结构，有助于安全进行腹腔镜胃切除术和机器人手术。
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