Zhao Xinzhe, Zhang Hongda, Zhao Hengyu, Kong Decan, Zeng Weijie, Gao Feng, Meng Xiaochun, Ke Jia
Department of general surgery (intestinal surgery), The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, People's Republic of China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, People's Republic of China.
Sci Rep. 2024 Dec 30;14(1):32054. doi: 10.1038/s41598-024-83588-w.
In hepatic flexure and transverse colon cancer surgeries, mobilizing the right mesocolon and precisely dissecting the gastrocolic trunk of Henle (GTH) are crucial. Previous classifications of GTH tributaries do not guide radical right hemicolectomy due to post-procedural anatomical acquisition. This study analyzed vessel associations, including the middle colic vein (MCV) converging site, right colic artery (RCA) presence, and other GTH tributaries, using ultra-thin CT for reconstruction. GTH anatomy was categorized into medial and lateral types based on colic tributary convergence relative to ASPDV. Results showed the colic tributary joined GTH lateral to ASPDV in 45.81% and medial in 54.19% of cases. RCA presence was strongly linked to the lateral GTH type (56.76% vs. 43.24%, p < 0.001) when RCA was absent. MCV converged into the superior mesenteric vein (SMV) on the left side in 23.15% of cases, correlating with the right colic vein presence (odds ratio = 3.563, p = 0.007). This novel GTH variation pattern via high-level CT venography significantly correlates with RCA presence, aiding surgeons in anticipating GTH anatomy during laparoscopic radical right hemicolectomy.
在肝曲和横结肠癌手术中,游离右结肠系膜并精确解剖亨勒胃结肠干(GTH)至关重要。由于术后解剖结构的变化,以往关于GTH分支的分类并不能指导根治性右半结肠切除术。本研究使用超薄CT进行重建,分析了血管关联,包括中结肠静脉(MCV)汇合部位、右结肠动脉(RCA)的存在情况以及其他GTH分支。根据结肠分支相对于胃网膜右静脉(ASPDV)的汇合情况,将GTH解剖结构分为内侧型和外侧型。结果显示,45.81%的病例中结肠分支在ASPDV外侧汇入GTH,54.19%的病例中结肠分支在ASPDV内侧汇入GTH。当RCA不存在时,RCA的存在与外侧GTH型密切相关(56.76%对43.24%,p < 0.001)。23.15%的病例中MCV在左侧汇入肠系膜上静脉(SMV),这与右结肠静脉的存在相关(比值比 = 3.563,p = 0.007)。这种通过高级CT静脉造影显示的新型GTH变异模式与RCA的存在显著相关,有助于外科医生在腹腔镜根治性右半结肠切除术中预判GTH的解剖结构。