摘要
目的腹腔镜胃癌根治手术中遇到胃周血管解剖变异时,常会影响术者判断而延长手术时间,甚至造成误伤引起手术并发症,而无法保证手术的安全和质量。本研究术前利用3D模拟软件重建多排CT(3D-CT)描述胃周血管腹腔干和脾动脉的变异情况,分析其描述的不同血管变异情况对腹腔镜全胃切除加D2淋巴清扫术(LTG+D_(2)LD)的指导作用。方法采用回顾性队列研究方法。病例纳入标准:(1)胃癌为进展期,术前均行消化内镜、64排增强CT扫描等检查,病理组织学诊断为胃腺癌;(2)重建了3D-CT模拟影像以指导手术;(3)均为同一组手术团队施行LTG+D_(2)LD手术;(4)临床资料齐全,患者均签署知情同意书。河南省人民医院胃肠外科2014年至2018年间98例胃癌患者入组。腹腔干的变异按Adachi的6个分类归纳为常见型(AdachiⅠ型)和罕见型(AdachiⅡ-Ⅵ型);脾动脉根据Natsume分类被分为"平坦型"和"弯曲型"。根据3D CT模拟影像,描述患者的腹腔干和脾动脉变异情况,比较不同动脉变异类型组间的手术时间、术中出血量以及术后检出淋巴结数的差异。结果本组患者腹腔干常见型84例(86%),罕见型14例,其中Ⅱ型6例(6%),Ⅲ型2例(2%),Ⅳ型2例(2%),Ⅴ型3例(3%),Ⅵ型1例(1%);未发现其他类型。腹腔干常见型与罕见型两组患者的临床特征及术中淋巴结检出数方面比较,差异均无统计学意义(均P>0.05)。与腹腔干常见型患者比较,罕见型患者的LTG+D_(2)LD手术时间长[(321.1±29.0)min比(295.1±46.5)min,t=2.081,P=0.040],术中出血量多(中位数:66.0 ml比32.0 ml,Z=-4.974,P=0.001),差异均有统计学意义。脾动脉平坦型患者41例(42%),弯曲型患者57例(58%),两组患者在一般临床特征及术中出血量、手术时间以及淋巴结检出数方面比较,差异均无统计学意义(均P>0.05)。结论 3D CT模拟影像描述胃周血管变异的方法对腹腔镜胃癌根治手术具有一定的临床价值。腹腔干�
Objective Anatomic variations in the perigastric vessels during laparoscopic radical gastrectomy often affect the operator's judgment and prolong the operation time,and even cause accidental injury and surgical complications,and hence the safety and quality of the operation cannot be ensured.In this study,multiple slice CT was reconstructed by 3-dimensional CT simulation software(3D-CT),and 3D-CT images were used to describe the variation of celiac trunk and splenic artery before surgery.The guiding role of the different variation of vessels was analyzed for laparoscopic total gastrectomy+D2 lymph node dissection(LTG+D2LD).Methods A retrospective cohort study was conducted.Case inclusion criteria:(1)Gastric cancer was at an advanced stage.All the patients were preoperatively examined by digestive endoscopy and 64-row enhanced CT scan,and were histopathologically diagnosed with gastric adenocarcinoma.(2)3D-CT simulation images were reconstructed to guide the operation.(3)LTG+D2LD surgery was performed by the same surgical team.(4)Clinical data were complete,and all the patients had signed the informed consent.From 2014 to 2018,98 patients with gastric cancer at the Gastrointestinal Surgery Department of Henan Provincial People's Hospital were enrolled.According to the Adachi classification,celiac trunk variation was divided into common type(Adachi type Ⅰ)and rare type(Adachi type Ⅱ-Ⅵ).According to the Natsume classification,splenic artery was classified into"flat type"and"curved type".Based on 3D-CT simulation images,variation of celiac trunk and splenic artery was described,and the differences in operation time,intraoperative blood loss and the number of postoperative retrieved lymph nodes were compared between groups with different types of arterial variation.Results For celiac trunk,common type was found in 84 cases(86%)and rare type was found in 14 cases,including 6 cases(6%)of type Ⅱ,2 cases(2%)of type Ⅲ,2 cases(2%)of type Ⅳ,3 cases(3%)of type Ⅴ,1 case(1%)of type Ⅵ.No other types were found.Th
作者
闫文锋
孙培春
吴刚
张建成
Yan Wenfeng;Sun Peichun;Wu Gang;Zhang Jiancheng(Department of Gastroenterology,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,School of Clinical Medicine,Henan University,Zhengzhou,Henan 450000,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2021年第2期173-178,共6页
Chinese Journal of Gastrointestinal Surgery
基金
河南省医学科技攻关计划项目(201702166)。
关键词
胃肿瘤
腹腔镜全胃切除术
胃周动脉变异
3D-CT模拟影像
Stomach neoplasms
Laparoscopic-assisted total gastrectomy
Variation of perigastric artery
3D-CT simulation image
