1Department of Radiology, the Affiliated Wuxi Second People's Hospital of Nanjing Medical University, Wuxi 214002, China; 2Department of Geners Surgeryl, the Affiliated Wuxi Second People's Hospital of Nanjing Medical University, Wuxi 214002, China
Abstract:Objective To study the anatomical characteristics of gastrocolic vein trunk(GCT) in vivo by using CT angiography (CTA) and image fusion.Methods From January 2017 to February 2018, 80 cases of abdominal CT plain scan and enhanced scan imaging data were analyzed retrospectively. In this study, there were 46 males and 34 females, aged 39-83(68±10.1) years. The original images were reconstructed by computed tomography angiography(CTA), computed tomography colonography(CTC) and fused to obtain three-dimensional images of blood vessels and intestines.Observation indexes included length, diameter and running of GCT, composition of GCT, distribution of the middle colon vein into the superior vein, distribution of superior venous confluence of anterior pancreaticoduodenal vein into superior vein.Results (1)Sixty-nine cases(86.25%) had GCT, the length was 2.5-25.2(9.2±3.6) mm, the average length was 3.3-7.2(4.8±0.9) mm. The trunk of the stomach and colon ran from the ventral to the right side. There were 4 origins of its branches: right colon vein, middle colon vein, right gastroepiploic vein and superior anterior pancreaticoduodenal vein. Among them, 35 cases(50.73%) consisted of right gastroepiploic vein, right colon vein and middle colon vein. In 7 cases(10.14%), the “2 branches” type of gastric and pancreatic trunk consisted of the right gastroduodenal vein and the anterior superior pancreaticoduodenal vein; 27 cases(39.13%) consisted of right colon vein, middle colon vein, right gastroepiploic vein and superior anterior pancreaticoduodenal vein. (2)The middle colon veins were found in 77 patients. Among of them, the middle colon vein entered superior mesenteric vein in the 53 patients (68.83%), entered GCT in the 20 patiens (25.97%), entered inferior mesenteric vein in the 2 patiens (2.60%), and entered splenic vein in the 2 patiens(2.60%). (3)The superior anterior pancreaticoduodenal vein directly entered the superior mesenteric vein in 46 cases(57.50%), and the superior anterior pancreaticoduodenal vein participated in the composition of GCT in 34 cases(42.50%), including 12 cases of right gastroepiploic vein, 10 cases of right colon vein, 7 cases of right omental vein and right colon vein. Five cases were enrolled in GCT.Conclusions CTA and image fusion technology can visually display the anatomy and variation of GCT vessels, provide reliable information for preoperative evaluation of abdominal vessels, and have high clinical value.
巫丹萍,卞琳杰,陈义钢,张追阳,倪建明,张雷,顾琛. 基于CT血管成像及图像融合技术的胃结肠静脉干的解剖学研究[J]. 中华解剖与临床杂志, 2019, 24(2): 133-137.
Wu Danping, Bian Linjie, Chen Yigang, Zhang Zhuiyang, Ni Jianming, Zhang Lei, Gu Chen. CT angiography and image fusion for anatomy of the gastric and colic trunk. Chinese Journal of Anatomy and Clinics, 2019, 24(2): 133-137.
Xie D, Yu C, Gao C, et al. An optimal approach for laparoscopic D3 lymphadenectomy plus complete mesocolic excision (D3+CME) for right-sided colon cancer[J]. Ann Surg Oncol, 2017, 24(5): 1312-1313. DOI:10.1245/s10434-016-5722-1.
[2]
Morneau M, Boulanger J, Charlebois P, et al. Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l′évolution des pratiques en oncologie[J]. Can J Surg, 2013, 56(5): 297-310. DOI:10.1503/cjs.005512.
[3]
Bae SU, Saklani AP, Lim DR, et al. Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer[J]. Ann Surg Oncol, 2014, 21(7): 2288-2294. DOI:10.1245/s10434-014-3614-9.
[4]
Ogino T, Takemasa I, Horitsugi G, et al. Preoperative evaluation of venous anatomy in laparoscopic complete mesocolic excision for right colon cancer[J]. Ann Surg Oncol, 2014, 21 Suppl 3: S429-S435. DOI:10.1245/s10434-014-3572-2.
[5]
Suzuki K, Morita S, Masukawa A, et al. Diagnosing a large slowly enhanced cerebral aneurysm using four-dimensional multiphase dynamic contrast-enhanced computed tomography angiography[J]. Jpn J Radiol, 2010, 28(9): 680-683. DOI:10.1007/s11604-010-0469-2.
[6]
Weber TF, Müller T, Biesdorf A, et al. True four-dimensional analysis of thoracic aortic displacement and distension using model-based segmentation of computed tomography angiography[J]. Int J Cardiovasc Imaging, 2014, 30(1): 185-194. DOI:10.1007/s10554-013-0307-6.
Ogino T, Takemasa I, Horitsugi G, et al. Preoperative evaluation of venous anatomy in laparoscopic complete mesocolic excision for right colon cancer[J]. Ann Surg Oncol, 2014, 21 Suppl 3: S429-S435. DOI:10.1245/s10434-014-3572-2.
[12]
Miyazawa M, Kawai M, Hirono S, et al. Preoperative evaluation of the confluent drainage veins to the gastrocolic trunk of Henle: understanding the surgical vascular anatomy during pancreaticoduodenectomy[J]. J Hepatobiliary Pancreat Sci, 2015, 22(5): 386-391. DOI:10.1002/jhbp.205.
Gillot C, Hureau J, Aaron C, et al. The superior mesenteric vein, an anatomic and surgical study of eighty-one subjects[J]. J Int Coll Surg, 1964, 41: 339-369.
Maki Y, Mizutani M, Morimoto M, et al. The variations of the middle colic vein tributaries: depiction by three-dimensional CT angiography[J]. Br J Radiol, 2016, 89(1063): 20150841. DOI:10.1259/bjr.20150841.
Hongo N, Mori H, Matsumoto S, et al. Anatomical variations of peripancreatic veins and their intrapancreatic tributaries: multidetector-row CT scanning[J]. Abdom Imaging, 2010, 35(2): 143-153. DOI:10.1007/s00261-007-9195-3.
[20]
Natsume T, Shuto K, Yanagawa N, et al. The classification of anatomic variations in the perigastric vessels by dual-phase CT to reduce intraoperative bleeding during laparoscopic gastrectomy[J]. Surg Endosc, 2011, 25(5): 1420-1424. DOI:10.1007/s00464-010-1407-1.
[21]
Tam MD, Latham T, Brown JR, et al. Use of a 3D printed hollow aortic model to assist EVAR planning in a case with complex neck anatomy: potential of 3D printing to improve patient outcome[J]. J Endovasc Ther, 2014, 21(5): 760-762. DOI:10.1583/14-4810L.1.