Heinze Tillmann, Heimke Marvin, Wedel Thilo, Benz Stefan Rolf
Klinik für Allgemein‑, Viszeral-, Thorax und Kinderchirurgie, Klinikum Sindelfingen-Böblingen, Kliniken Böblingen, Bunsenstr. 120, 71032, Böblingen, Deutschland.
Anatomisches Institut, Zentrum für Klinische Anatomie, Kurt-Semm-Zentrum für laparoskopische und roboterassistierte Chirurgie, Universität Kiel, Kiel, Deutschland.
Chirurgie (Heidelb). 2025 Aug 7. doi: 10.1007/s00104-025-02342-8.
Oncological right hemicolectomy requires central ligation of all blood vessels supplying the right colon. This includes the ileocolic, right and middle colic vessels. The vascular variants comprise the prevalence, number, origin as well as the trajectory and involve both the arterial and venous systems. The course of the ileocolic artery ventral or dorsal to the superior mesenteric vein, the frequent absence of the right colic artery, the variable bifurcation of the middle colic artery and the presence of an accessory middle colic artery are of particular relevance. Venous drainage of the ascending colon and right colic flexure is provided by the right/right superior colic veins which frequently drain together with veins from the greater gastric curvature and the pancreatic head into the gastropancreaticocolic trunk (trunk of Henle). The surgical vascular management requires detailed knowledge of these vascular variants. Prevention of vascular complications is best accomplished by a preoperative vascular mapping, e.g., computed tomography (CT) angiography, AMIGO system, 3D reconstruction and the application of the critical view/open book concept.
肿瘤性右半结肠切除术需要对供应右半结肠的所有血管进行中央结扎。这包括回结肠血管、右结肠血管和中结肠血管。血管变异包括发生率、数量、起源以及走行，涉及动脉和静脉系统。回结肠动脉在肠系膜上静脉腹侧或背侧的走行、右结肠动脉常缺如、中结肠动脉的分叉多变以及副中结肠动脉的存在尤为重要。升结肠和右结肠曲的静脉引流由右/右上结肠静脉提供，这些静脉常与来自胃大弯和胰头的静脉一起汇入胃胰结肠干（亨勒干）。手术中的血管处理需要详细了解这些血管变异。预防血管并发症的最佳方法是术前进行血管造影，例如计算机断层扫描（CT）血管造影、AMIGO系统、三维重建以及应用关键视野/开放视野概念。
