摘要
目的:探讨双层探测器光谱CT 40 keV单能级成像对胃结肠静脉干及其属支的解剖变异评价。方法:收集2020年8月—2021年8月在昆明医科大学第一附属医院胃肠外科收治的49例右半结肠癌患者的临床资料,所有患者均行光谱CT增强扫描,其中男34例,女15例,年龄37~88(61.72±15.98)岁。将静脉期原始图像重建成40 keV的单能级能谱图像,记录胃结肠静脉干及属支解剖情况(胃网膜右静脉、胰十二指肠上前静脉、副右结肠静脉、右结肠静脉和中结肠静脉),测量胃结肠静脉干的长度、直径,并观察解剖分型与术中结果一致性。结果:49例中47例(95.92%)显示胃结肠静脉干,且40 keV单能级成像下各血管与术中腹腔镜所见血管一致率达100%(47/47)。47例胃结肠静脉干均自腹侧至头侧向右走行,根部多紧贴胰腺下缘。其长度为8.05~27.80(14.79±4.78) mm,管腔直径为2.93~7.36(5.2±1.04) mm。胃结肠静脉干0、Ⅰ、Ⅱ、Ⅲ型出现率分别为6.38%、59.57%、29.79%、4.26%。46例(93.88%)患者存在副右结肠静脉,多自结肠肝曲处走行且最终均汇入胃结肠静脉干。43例(87.76%)患者存在右结肠静脉,多沿胰头附近走行,最终34例汇入肠系膜上静脉,9例汇入胃结肠静脉干。44例(89.80%)患者存在中结肠静脉,多沿胰头附近走行,最终37例汇入肠系膜上静脉,7例汇入胃结肠静脉干。结论:胃结肠静脉干变异复杂多变,术前采用光谱CT 40 keV单能级成像可对胃结肠静脉干及其属支的解剖变异进行准确判读,减少术中不必要的失误,确保患者手术成功和良好预后。
Objective: To evaluate the anatomic variation of the gastrocolonic trunk of Henle(GTH) by dual-layer spectral detector CT 40 keV virtual mono-energetic images. Methods: 49 patients who underwent laparoscopic right colectomies from August 2020 to August 2021 in the First Affiliated Hospital of Kunming Medical University were enrolled in the study. All patients received dual-layer spectral CT enhanced scanning, including 34 males and 15 females, aged 37 ~88(61.72 ±15.98)years old. The original images of the venous phase were reconstructed into 40 keV mono-energetic images. The anatomy of GTH and its branches(RGEV, ASPDV, SRCV, RCV, MCV) were analyzed, and the length and diameter of the GTH were measured. The consistency between the anatomical classification and the intraoperative results was observed. Results: Of the49 patients, 47(95.92%) showed the GTH. The consistency rate of GTH with intraoperative laparoscopic vessels under 40 keV mono-energetic images was 100%(47/47). In 47 cases, the GTH ran from the ventral side to the head side, and the root was mostly close to the lower edge of the pancreas. The length was 8.05~27.80(14.79±4.78) mm, and the diameter was 2.93~7.36(5.2±1.04) mm. The incidence of 0,Ⅰ, Ⅱ, Ⅲ in GTH was 6.38%, 59.57%, 29.79% and 4.26%. 46 patients(93.88%) had the SRCV which ran from the colonic hepatic flexure and eventually flowed into the GTH. 43 patients(87.76%) had the RCV which ran along the head of the pancreas, 34 cases flowed into the SMV, and 9 cases flowed into the GTH. 44 patients(89.80%) had the MCV which ran along the head of the pancreas, 37 cases flowed into the SMV, and 7 cases flowed into the GTH. Conclusion: The variation of the GTH is complex and variable. Preoperative 40 keV mono-energetic images can accurately interpret the anatomic variation of the GTH, reduce unnecessary errors during operation, and ensure the successful operation and good prognosis of patients.
作者
付蓝琦
陈羲箐
潘馨梦
雷静
杨亚英
FU Lan-qi;CHEN Xi-jing;PAN Xin-meng;LEI Jing;YANG Ya-ying(The First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)
出处
《中国临床医学影像杂志》
CAS
CSCD
2022年第6期409-413,共5页
Journal of China Clinic Medical Imaging
