D3 左半结肠切除术患者的临床疗效和血管解剖放射学评估。

IF 0.5 4区 医学 Q4 SURGERY
Stepan Y Grytsenko, Ihor Y Dzyubanovsky, Anatoliy D Bedeniuk, Ivanna Y Hrytsenko, Andriy M Prodan
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引用次数: 0

摘要

背景:充足的血液供应是结直肠吻合愈合的关键因素之一。在手术过程中,血管解剖的各种变异常常令外科医生感到惊讶:本研究旨在对三维计算机断层扫描(3D-CT)血管造影数据与术中数据进行对比分析,并对脾曲解剖变异进行详细分析:在这项研究中,我们纳入了103名左侧结肠癌和直肠癌患者(男56名,女47名;平均年龄(64.2±11.6)岁),他们于2016年至2022年间在特尔诺皮尔大学医院接受了术前3D-CT血管造影检查:根据最近提出的分类,结肠脾曲的血供有四种类型:我们的分析显示,83 例(80.6%)患者为 1 型,9 例(8.7%)为 2 型,10 例(9.7%)为 3 型,1 例(1%)为 4 型。所有患者都接受了局部左侧根治性半结肠切除术,包括完整的结肠系膜切除术(CME)、中央血管结扎术(CVL)和切除术(R0)。其中 7 例采用腹腔镜手术,切除淋巴结的中位数为 21.54 ± 7.32。24.3%的病例淋巴结呈阳性。1例患者被诊断为AL:通过三维 CT 血管造影术对血管解剖进行仔细的术前分析,可以评估结肠脾曲的血管情况,减少术中识别结构的时间,并制定个性化的手术策略,从而降低吻合口漏的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical outcomes and radiological assessment of vascular anatomy in patients who underwent D3 left hemicolectomy.

Background: Adequate blood supply is one of the key factors for colorectal anastomosis healing. Various variants of vascular anatomy often come as a surprise to surgeons during operations.

Objectives: The aims of this study were to carry out a comparative analysis of three-dimensional-computed tomography (3D-CT) angiography data with intraoperative data and a detailed analysis of variants of the anatomy of splenic flexure.

Material and methods: In this study, we included 103 patients (56 males and 47 females; mean age 64.2 ± 11.6) with the left-sided colon and rectal cancer who underwent preoperative 3D-CT angiography at Ternopil University Hospital between 2016 and 2022.

Results: According to the recently proposed classification, there are four types of blood supply to the splenic flexure of the colon: Our analysis showed that type 1 was found in 83 (80.6%) patients, type 2 in 9 (8.7%), type 3 in 10 (9.7%), and type 4 in 1 (1%). All patients underwent local left radical hemicolectomy with resection of complete mesocolic excision (CME), central vascular ligation (CVL) and resección (R0). Seven cases were operated laparoscopically; and the median quantity of removal lymph nodes was 21.54 ± 7.32. Positive lymph nodes were revealed in 24.3% cases. AL was diagnosed in one patient.

Conclusions: Careful pre-operative analysis of vascular anatomy on 3D-CT angiography will assess the vascularization of the splenic flexure of the colon, reduce intraoperative time to identify structures, and develop a personalized strategy for surgery which potentially can reduce the risk of anastomotic leakage.

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来源期刊
Cirugia Y Cirujanos
Cirugia Y Cirujanos 医学-外科
CiteScore
0.90
自引率
20.00%
发文量
207
审稿时长
6-12 weeks
期刊介绍: Cirugía y Cirujanoses exponente del desarrollo académico, científico, médico, quirúrgico y tecnológico en materia de salud en México y en el ámbito internacional. Es una revista bimestral, open access, revisada por pares, que publica en español y en inglés (traducido sin coste para los autores) artículos científicos originales, casos clínicos, artículos de revisión de interés general y cartas al editor. Los artículos se seleccionan y publican siguiendo un riguroso análisis, de acuerdo con los estándares internacionalmente aceptados. Sus espacios están abiertos a los académicos, así como a todo miembro de la comunidad médica que manifieste interés por utilizar este foro para publicar sus trabajos.
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