多层螺旋CT血管成像在腹腔镜右半结肠手术中的应用价值
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摘要
目的:探讨多层螺旋CT血管成像在腹腔镜右半结肠手术中的应用价值。方法:回顾分析2016年8月1日至2018年8月1日行腹腔镜手术治疗的62例右半结肠癌患者的临床资料及影像学资料,比较术前CT提供的血管资料及术中探查的结果。结果:图像结果与术中涉及的主要血管探查情况符合率较好,分支血管符合率大于90%。其中肠系膜上静脉血管术中探查情况与术前血管三维重建图像完全符合,符合率100%;回结肠动静脉术中与术前相比,1例存在差异,符合率98.39%; Henle干术中与术前分支、走行符合率为100%;结肠中动脉术中与术前相比,4例存在差异,符合率93.55%。结论:术前应用多层螺旋CT血管成像可清晰反应血管的分支、变异、走向,在结肠癌腹腔镜手术中具有较高的实用价值,值得推广。
Objective: To explore the value of the multi-slice spiral CT angiography in laparoscopic right colon surgery.Methods: The clinical and imaging data of 62 patients with right colon cancer who underwent laparoscopic surgery from August 1,2016 to August 1,2018 were retrospectively analyzed.The vascular data of preoperative CT and intraoperative finding were compared.Results:The image results were in good agreement with the main vascular exploration in the operation,and the branch vessel compliance rate was greater than 90%.The intraoperative exploration of the superior mesenteric vein was in complete agreement with the three-dimensional reconstruction of the preoperative vessel,and the coincidence rate was 100%.There was one case of ileocolic arteriovenous difference between the intraoperative exploration and the preoperative image,and the coincidence rate was 98.39%. The coincidence rate of Henle trunk branch and running between the operation and the preoperation was 100%.There were 4 cases with difference in the middle colon arteries between intraoperation and preoperation,and the coincidence rate was 93.55%.Conclusions: Preoperative multi-slice spiral CT angiography can clearly reflect the branching,variation and trend of blood vessels.It has high practical value in laparoscopic surgery for colon cancer and is worthy of promotion.
Objective: To explore the value of the multi-slice spiral CT angiography in laparoscopic right colon surgery.Methods: The clinical and imaging data of 62 patients with right colon cancer who underwent laparoscopic surgery from August 1,2016 to August 1,2018 were retrospectively analyzed.The vascular data of preoperative CT and intraoperative finding were compared.Results:The image results were in good agreement with the main vascular exploration in the operation,and the branch vessel compliance rate was greater than 90%.The intraoperative exploration of the superior mesenteric vein was in complete agreement with the three-dimensional reconstruction of the preoperative vessel,and the coincidence rate was 100%.There was one case of ileocolic arteriovenous difference between the intraoperative exploration and the preoperative image,and the coincidence rate was 98.39%. The coincidence rate of Henle trunk branch and running between the operation and the preoperation was 100%.There were 4 cases with difference in the middle colon arteries between intraoperation and preoperation,and the coincidence rate was 93.55%.Conclusions: Preoperative multi-slice spiral CT angiography can clearly reflect the branching,variation and trend of blood vessels.It has high practical value in laparoscopic surgery for colon cancer and is worthy of promotion.
引文
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[11]刘祖定,伍家发,刘中宁,等.腹腔镜中间入路逆行法右半结肠癌D3根治术的手术要点与难点分析[J].中国微创外科杂志,2014,14(8):741-743,754.
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[13]张正铿,江燕萍,张树桐,等.多层螺旋CT增强扫描结合血管造影对结肠癌术前评估价值探讨[J].实用医学杂志,2013,29(24):4056-4058.
[14]朱达坚,陈小伍,剧永乐,等.以回结肠血管为标记右下入路在腹腔镜根治性右半结肠切除术中的临床应用[J].实用医学杂志,2012,28(12):2039-2041.
[15]赵丽瑛,李国新,张策,等.腹腔镜下右半结肠血管解剖及血管并发症分析[J].中华胃肠外科杂志,2012,15(4):336-341.
[16]孔祥恒,杨道贵,张彦波,等.腹腔镜右半结肠全结肠系膜切除术操作流程的优化[J].腹腔镜外科杂志,2017,22(3):173-176.
[17]刁德昌,卢新泉,何耀彬,等.动脉优先入路法腹腔镜右半结肠癌根治术的可行性及应用价值[J].中华胃肠外科杂志,2017,20(1):90-93.
[18]李勇,吴德庆,王俊江.腹腔镜右半结肠癌根治术的难点和技巧[J].中华胃肠外科杂志,2014,17(8):768-771.
[19]Lange JF,Koppert S,van Eyck CH,et al.The gastrocolic trunk of Henle in pancreatic surgery:an anatomo-clinical study[J].JHepatobiliary Pancreat Surg,2000,7(4):401-103.
[20]冯波,严夏霖,张森,等.腹腔镜右半结肠癌根治术Henle干的解剖技巧[J].中华胃肠外科杂志,2017,20(6):635-638.
[21]孙跃明.腹腔镜右半结肠癌根治术难点与关键技术[J/CD].中华普外科手术学杂志(电子版),2017,11(2):102-104.
[22]童宜欣,龚建平.右半结肠癌D3+CME关键技术[J/CD].中华结直肠疾病电子杂志,2017,6(4):280-283.
[23]牟东成,杨国山,朱建平,等.腹腔镜扩大右半结肠癌根治术手术体会[J].中国临床医生杂志,2018,46(1):57-59.
[24]于海涛,李国新,张策,等.腹腔镜中间入路法右半结肠切除术解剖学观察[J].中国临床解剖学杂志,2008,26(5):477-480.
[2]陈炜.腹腔镜下右半结肠癌根治术不同手术入路的疗效比较[J/CD].中华临床医师杂志(电子版),2014,8(14):2619-2622.
[3]史建中,钱山青,孙卫东,等.中间入路法腹腔镜右半结肠癌根治术55例临床体会[J].腹腔镜外科杂志,2016,21(10):742-745.
[4]郑民华,马君俊.腹腔镜结直肠手术手术入路选择专家共识[J].中国实用外科杂志,2017,37(4):415-419.
[5]雷晓东,邓伟均,李苏明,等.入路位置对手助腹腔镜右半结肠癌根治术的效果影响[J].国际医药卫生导报,2013,19(18):2846-2849.
[6]池畔,陈致奋.腹腔镜右半结肠癌根治术解剖学基础与规范化手术[J/CD].中华普外科手术学杂志(电子版),2015,9(1):7-13.
[7]郑民华.我国腹腔镜手术并发症现状和防治对策[J].中国实用外科杂志,2007,27(9):679-681.
[8]王晓霞.多层螺旋CT检查诊断结肠癌的效果观察[J].世界最新医学信息文摘,2017,17(96):159.
[9]李平.多层螺旋CT扫描在结肠癌术前分期中的应用[J].当代医学,2018,24(13):99-100.
[10]岳沪宁.螺旋CT对进展期结肠癌诊断与分期的价值[J].中国继续医学教育,2017,9(23):58-59.
[11]刘祖定,伍家发,刘中宁,等.腹腔镜中间入路逆行法右半结肠癌D3根治术的手术要点与难点分析[J].中国微创外科杂志,2014,14(8):741-743,754.
[12]史建中,钱山青,孙卫东,等.中间入路法腹腔镜右半结肠癌根治术55例临床体会[J].腹腔镜外科杂志,2016,21(10):742-745.
[13]张正铿,江燕萍,张树桐,等.多层螺旋CT增强扫描结合血管造影对结肠癌术前评估价值探讨[J].实用医学杂志,2013,29(24):4056-4058.
[14]朱达坚,陈小伍,剧永乐,等.以回结肠血管为标记右下入路在腹腔镜根治性右半结肠切除术中的临床应用[J].实用医学杂志,2012,28(12):2039-2041.
[15]赵丽瑛,李国新,张策,等.腹腔镜下右半结肠血管解剖及血管并发症分析[J].中华胃肠外科杂志,2012,15(4):336-341.
[16]孔祥恒,杨道贵,张彦波,等.腹腔镜右半结肠全结肠系膜切除术操作流程的优化[J].腹腔镜外科杂志,2017,22(3):173-176.
[17]刁德昌,卢新泉,何耀彬,等.动脉优先入路法腹腔镜右半结肠癌根治术的可行性及应用价值[J].中华胃肠外科杂志,2017,20(1):90-93.
[18]李勇,吴德庆,王俊江.腹腔镜右半结肠癌根治术的难点和技巧[J].中华胃肠外科杂志,2014,17(8):768-771.
[19]Lange JF,Koppert S,van Eyck CH,et al.The gastrocolic trunk of Henle in pancreatic surgery:an anatomo-clinical study[J].JHepatobiliary Pancreat Surg,2000,7(4):401-103.
[20]冯波,严夏霖,张森,等.腹腔镜右半结肠癌根治术Henle干的解剖技巧[J].中华胃肠外科杂志,2017,20(6):635-638.
[21]孙跃明.腹腔镜右半结肠癌根治术难点与关键技术[J/CD].中华普外科手术学杂志(电子版),2017,11(2):102-104.
[22]童宜欣,龚建平.右半结肠癌D3+CME关键技术[J/CD].中华结直肠疾病电子杂志,2017,6(4):280-283.
[23]牟东成,杨国山,朱建平,等.腹腔镜扩大右半结肠癌根治术手术体会[J].中国临床医生杂志,2018,46(1):57-59.
[24]于海涛,李国新,张策,等.腹腔镜中间入路法右半结肠切除术解剖学观察[J].中国临床解剖学杂志,2008,26(5):477-480.