多层螺旋CT腹腔干重建在腹腔镜胃癌根治术术前评价的价值  

Multi-Slice Spiral CT Angiography of the Celiac Trunk in Preoperative Evaluation of Laparoscopic-Assisted Gastrectomy for Advanced Gastric Carcinoma

作　　者：何威[1,2] 余江[1] 张策[1] 王亚楠[1] 胡彦锋[1] 成官迅[3] 李国新[1] 

机构地区：[1]南方医科大学南方医院普通外科,广州510515 [2]佛山市顺德区第一人民医院外二科,佛山528300 [3]南方医科大学南方医院影像中心,广州510515

出　　处：《中国微创外科杂志》2009年第12期1119-1121,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：广东省科技计划项目(2006B12901006);广州市科技攻关项目(2006Z3-E0571)

摘　　要：目的评价多层螺旋CT血管造影(multi-slice spiral CT angiography,MSCTA)对腹腔干及其分支血管的三维重建能力,探讨MSCTA在进展期胃癌腹腔镜手术前的评估价值。方法25例拟行腹腔镜辅助胃癌D2根治术行腹部螺旋CT增强扫描,用容积再现(volume rendering,VR)进行三维血管造影(CT angiography,CTA),根据其CTA表现评价腹腔干及其分支血管的空间解剖特征,将所得的解剖学资料与腹腔镜下血管解剖对比。结果MSCTA准确显示胃左动脉25例,胃右动脉12例,胃十二指肠动脉全部显示,其中胃十二指肠动脉2例起自肝左动脉,1例起自肝右动脉。脾动脉起源相对固定。根据MSCTA结果指导腹腔镜下进展期胃癌D2根治术,手术均顺利完成,无中转开腹。重建的腹腔干及分支与术中活体解剖完全吻合。结论MSCTA能清晰显示腹腔动脉解剖和正确的空间关系,是一种有价值的腹腔镜辅助进展期胃癌D2根治术术前检查方法,可能为相关血管周围淋巴结的清扫提供线索。Objective To evaluate the ability of multi-slice spiral CT angiography（MSCTA）in showing the celiac trunk and its degree branches,and the value of MSCTA in preoperative evaluation of laparoscopic-assisted gastrectomy for advanced gastric carcinoma.Methods A total of 25 consecutive patients scheduled for laparoscopic-assisted gastrectomy with D2 lymph node dissection were evaluated by MSCT,CT angiography（CTA）were reconstructed separately using a volume rendering algorithm（VR）.The space anatomy characteristics of celiac artery and its degree branches were evaluated according to the CTA results,and with anatomy information,laparoscopic-assisted gastrectomy with D2 lymph node dissection was processed with references to anatomy.Results In all the 25 cases,the left gastric artery and gastroduodenal artery were accurately identified on MSCTA.In 12 of them,the right gastric artery was accurately identified.The origin of the spleen artery is relatively constant.Laparoscopic-assisted gastrectomy with D2 lymph node dissection was successfully completed without conversion to open surgery in all the cases.The reconstructed celiac trunk and branches are identical with anatomy.Conclusions Three-dimensional CTA using MSCT clearly reveals the anatomy of celiac artery and their space structure.It plays an important role in guiding lymph node dissection during laparoscopic-assisted gastrectomy for advanced gastric carcinoma.

关 键 词：腹腔动脉 多层螺旋CT血管造影 腹腔镜 胃癌根治术 

分 类 号：R735.2[医药卫生—肿瘤]