肠系膜上血管及其属支临床解剖研究
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摘要
目的观察分析腹腔镜手术肠系膜上血管主干和属支在十二指肠胰头区域的解剖情况。方法选择2016年7月至2017年1月北京协和医院基本外科收治的共27例腹腔镜右半结肠癌完整结肠系膜切除(CME)病人,观察回结肠血管、右结肠血管、中结肠血管的动静脉出现率和毗邻关系,以及胃结肠干的出现率和属支情况。结果术中观察发现,回结肠血管出现率为100%,右结肠动脉、静脉的出现率分别为33.3%和11.1%,中结肠动脉、静脉的出现率分别为88.9%和92.6%。中结肠动脉的长度为1.9(0~7.2)cm。胃结肠干的出现率为92.6%;由2~5支属支汇合而成;主干的长度为0.8(0.2~2.4)cm。结论回结肠血管出现率高,可以做为手术解剖的首要步骤;肠系膜上血管在十二指肠胰头区域的解剖结构复杂,术者应该充分了解该区域解剖关系。
Objective To study the surgical anatomy of superior mesenteric vessels and its distributaries in the pancreaticoduodenal area. Methods The prospective observational trial included 27 patients performed laparoscopic complete mesocolic excision(CME) procedure in order to study the anatomical artery-vein relationships of the ileocolic vessels,right colic vessels,middle colic vessels,and the configurationally relationship of the distributaries to Henle's trunk. Results Ileocolic vessels were found in each patient. The probability of right colic artery and vein were 33.3%and 11.1% respectively. The middle colic artery and vein were found at a rate of 88.9% and 92.6% respectively. The length of middle colic artery was 1.9(0 to 7.2)cm. The probability of Henle's trunk was 92.6%,with the length of 0.8(0.2 to 2.4)cm. There were 2 to 5 branches drained into Henle's trunk. Conclusion Laparoscopic CME procedure should start at dissecting ileocolic vessles,because of its constant location. Getting familiar with the complicated anatomic configuration of pancreaticoduodenal area would be helpful to precisional surgery.
Objective To study the surgical anatomy of superior mesenteric vessels and its distributaries in the pancreaticoduodenal area. Methods The prospective observational trial included 27 patients performed laparoscopic complete mesocolic excision(CME) procedure in order to study the anatomical artery-vein relationships of the ileocolic vessels,right colic vessels,middle colic vessels,and the configurationally relationship of the distributaries to Henle's trunk. Results Ileocolic vessels were found in each patient. The probability of right colic artery and vein were 33.3%and 11.1% respectively. The middle colic artery and vein were found at a rate of 88.9% and 92.6% respectively. The length of middle colic artery was 1.9(0 to 7.2)cm. The probability of Henle's trunk was 92.6%,with the length of 0.8(0.2 to 2.4)cm. There were 2 to 5 branches drained into Henle's trunk. Conclusion Laparoscopic CME procedure should start at dissecting ileocolic vessles,because of its constant location. Getting familiar with the complicated anatomic configuration of pancreaticoduodenal area would be helpful to precisional surgery.
引文
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[2]Hirai K,Yoshinari D,Ogawa H,et al.Three-dimensional computed tomography for analyzing the vascular anatomy in laparoscopic surgery for right-sided colon cancer[J].Surg Laparosc Endosc Percutan Tech,2013,23(6):536-539.
[3]Tajima Y,Ishida H,Ohsawa T,et al.Three-dimensional vascular anatomy relevant to oncologic resection of right colon cancer[J].Int Surg,2011,96(4):300-304.
[4]Lee SJ,Park SC,Kim MJ,et al.Vascular anatomy in laparoscopic colectomy for right colon cancer[J].Dis Colon Rectum,2016,59(8):718-724.
[5]人体解剖学与组织胚胎学名词审定委员会.人体解剖学名词[M].2版.北京:科学出版社,2013.
[6]肖毅.腹腔镜下根治性右半结肠切除术[J].国际外科学杂志,2014,41(8):572-574.
[7]Haywood M,Molyneux C,Mahadevan V,et al.The right colic artery:An anatomical demonstration and its relevance in the laparoscopic era[J].Ann R Coll Surg Engl,2016,98(8):560-563.
[8]Freund MR,Edden Y,Reissman P,et al.Iatrogenic superior mesenteric vein injury:the perils of high ligation[J].Int J Colorectal Dis,2016,31(9):1649-1651.
[9]楼文晖,方圆.胰腺颈部断裂伤手术指征及术式选择[J].中国实用外科杂志,2015,35(3):262-265.