Efetov S K, Zubayraeva A A, Rychkova A K
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Khirurgiia (Mosk). 2024(10):29-37. doi: 10.17116/hirurgia202410129.
To provide a personalized approach to D3 lymph node dissection (LND) in right colon cancer using a proper analysis and interpretation of CT angiography of superior mesenteric vessels.
An observational cross-sectional study included 34 patients who underwent surgery for right colon cancer with D3 LND along superior mesenteric artery (SMA) and vein (SMV). Characteristics of surgically relevant vascular anatomy were evaluated as 0 or 1 depending on complexity of anatomical characteristic. Patients were classified into groups of standard (0 points) and complex (1-3 points) LND according to complexity of vascular anatomy.
SMA and SMV crossed each other at the level of ileocolic artery (ICA) orifice or above in 23.5% of cases (=8). In 76.5% of cases, they passed parallel to each other (=25). Ileocolic artery passed posteriorly to SMV in 47.1% (=16) of cases. A closed type of SMA with a restricted access to D3 area was observed in 41.2% of cases (=14). Duration of LND significantly differed (43.6±17.8 min in standard cases and 61.9±18.6 min in complex ones, =0.006).
CONCLUSION. V: Ascular anatomy can predict complexity of D3 LND in right colon cancer surgery. The complexity scale is an important tool for preoperative planning of D3 LND and identifying technical difficulties associated with vascular anatomy.
通过对肠系膜上血管CT血管造影进行恰当分析和解读，为右半结肠癌的D3淋巴结清扫术（LND）提供个性化方法。
一项观察性横断面研究纳入了34例行右半结肠癌手术并沿肠系膜上动脉（SMA）和静脉（SMV）进行D3淋巴结清扫的患者。根据解剖特征的复杂程度，将手术相关血管解剖特征评估为0或1。根据血管解剖的复杂程度，将患者分为标准（0分）和复杂（1 - 3分）淋巴结清扫组。
在23.5%（=8）的病例中，SMA和SMV在回结肠动脉（ICA）开口水平或以上交叉。在76.5%的病例中，它们相互平行（=25）。在47.1%（=16）的病例中，回结肠动脉走行于SMV后方。在41.2%（=14）的病例中观察到一种进入D3区域受限的闭合型SMA。淋巴结清扫持续时间有显著差异（标准病例为43.6±17.8分钟，复杂病例为61.9±18.6分钟，=0.006）。
血管解剖可预测右半结肠癌手术中D3淋巴结清扫的复杂性。复杂性评分是D3淋巴结清扫术前规划以及识别与血管解剖相关技术难点的重要工具。
