Chen Jinghao, Tian Hao, Yu Ke, Tao Shumin, Bai Bin, Song Anyi, Gu Hongmei
Department of Medical Imaging, Nantong University Affiliated Hospital, Nantong, China.
J Gastrointest Oncol. 2025 Aug 30;16(4):1461-1473. doi: 10.21037/jgo-2025-167. Epub 2025 Aug 22.
The superior mesenteric artery (SMA) has numerous branches and a high rate of anatomical variation, making it challenging to manage during surgery. This study aimed to evaluate the clinical utility of dual energy computed tomography (CT) three-dimensional (3D) reconstruction combined with arteriovenous image fusion technology for assessing SMA variations. The goal is to aid in surgical planning for laparoscopic radical resection of right colon cancer, using the SMA as the primary surgical approach.
We performed a retrospective analysis of clinical and imaging data from patients with right colon cancer who underwent enhanced spectral CT of the abdomen and pelvis before surgery at Nantong University Affiliated Hospital from January 2020 to June 2024. Using post-processing techniques to reconstruct SMA images, the study evaluated the SMA root position, measured the distance between the roots of the right branches of the SMA, analyzed their relationship with patient gender and body mass index (BMI), and summarized the types of right branches of the SMA. Additionally, the relationship between the middle colic artery (MCA), right colic artery (RCA), ileocolic artery (ICA), and the superior mesenteric vein (SMV) positions were analyzed in relation to patient clinical characteristics.
The SMA root was mostly located at the L1 vertebral level (74.68%, 236/316), with a vertebral range between T12-L2. The distance from the SMA root to the abdominal aorta (D) was 115.97±11.82 mm, and this distance increased with higher BMI in males. Type I SMA (presence of RCA) accounted for 39.87% (126/316), Type II (absence of RCA) accounted for 60.13% (190/316), with the distance between the root of the MCA and the ICA (d) being longer in type II. 91.27% (115/126) of the RCA was anterior to the SMV. When the RCA was posterior, the ICA was always posterior to the SMV. The ICA was anterior to the SMV in about 50.63% (160/316) of cases, with a higher incidence in males and those with a shorter d.
Spectral CT 3D reconstruction and arteriovenous image fusion technology can accurately assess the anatomical features of the SMA and the relationship between the right branch vessels and the SMV, helping to develop reasonable surgical plans for laparoscopic radical right hemicolectomy in patients with right colon cancer using an "SMA-prioritized approach".
肠系膜上动脉（SMA）分支众多，解剖变异率高，手术中处理难度大。本研究旨在评估双能计算机断层扫描（CT）三维（3D）重建联合动静脉图像融合技术在评估SMA变异中的临床应用价值。目标是辅助以SMA为主要手术入路的右半结肠癌腹腔镜根治性切除术的手术规划。
对2020年1月至2024年6月在南通大学附属医院接受术前腹部和盆腔增强光谱CT检查的右半结肠癌患者的临床和影像资料进行回顾性分析。利用后处理技术重建SMA图像，本研究评估了SMA根部位置，测量了SMA右支根部之间的距离，分析了它们与患者性别和体重指数（BMI）的关系，并总结了SMA右支的类型。此外，还分析了中结肠动脉（MCA）、右结肠动脉（RCA）、回结肠动脉（ICA）与肠系膜上静脉（SMV）位置之间的关系及其与患者临床特征的相关性。
SMA根部大多位于L1椎体水平（74.68%，236/316），椎体范围在T12-L2之间。SMA根部至腹主动脉的距离（D）为115.97±11.82mm，该距离在男性中随BMI升高而增加。I型SMA（存在RCA）占39.87%（126/316），II型（不存在RCA）占60.13%（190/316），II型中MCA与ICA根部之间的距离（d）更长。91.27%（115/126）的RCA位于SMV前方。当RCA位于后方时，ICA总是位于SMV后方。约50.63%（160/316）的病例中ICA位于SMV前方，男性及d较短者发生率更高。
光谱CT 3D重建和动静脉图像融合技术可准确评估SMA的解剖特征以及右支血管与SMV之间的关系，有助于为右半结肠癌患者采用“以SMA优先入路”的腹腔镜根治性右半结肠切除术制定合理的手术方案。
