腹腔镜下右侧结肠血管解剖学观察及术中出血的临床分析  

Vascular anatomy of the right colon and intraoperational bleeding during laparascopic surgery

作　　者：封益飞 吉冰 张悦 季东健 张冬生 胥子玮 王勇[1] 傅赞 孙跃明 FengYifei;Ji Bin;Zhang Yue;Ji Dongjian;Zhang Dongsheng;Xu Ziwei;Wang Yong;Fu Zan;Sun Yueming(Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院结直肠外科,210029

出　　处：《中华结直肠疾病电子杂志》2017年第6期478-483,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：教育部基金项目(No.2012YQ030261);江苏省科技厅基础研究计划(No.BK20131448)

摘　　要：目的探讨腹腔镜下右侧结肠的血管解剖关系并分析不同血管出血的临床特征。方法采集2014年12月至2016年12月间南京医科大学第一附属医院结直肠外科完成的245例腹腔镜右半结肠癌根治术的手术录像,分析右侧结肠血管的解剖关系及其对手术进程的影响。结果肠系膜上动静脉、回结肠动静脉出现几率均是100%。回结肠动脉位于静脉后方者更多见,共142例(58.0%)。右结肠动脉独立发自肠系膜上动脉者56例(22.9%),均经肠系膜上静脉前方跨过。本组病例中227例患者(92.7%)存在胃结肠静脉干(Henle氏干)。其中以胃网膜右静脉和右结肠静脉形成的胃结肠干(33.9%)以及胃网膜右静脉、右结肠静脉和胰十二指肠前静脉汇合成的胃胰结肠干(34.7%)最多见。本研究中出现术中出血47例,占总病例数的19.2%。其中动脉性出血16例(6.5%),胰腺实质出血会明显延长腹腔镜手术时间(t=2.895,P<0.05),而其他动脉性出血并不会延长手术时间(均P>0.05)。静脉性出血31例患者(12.7%),大部分为胃结肠静脉干属支出血。统计结果显示,术中出现静脉出血并发症均会延长手术时间(P<0.05)。结论右侧结肠血管解剖变异较多,术中血管出血概率较高,以静脉出血多见且较难处理,明显延长腹腔镜手术时间。深刻理解腹腔镜下右半结肠血管的解剖关系,尤其是胃结肠静脉干的解剖有利于减少术中出血的发生。Objective To summarize vascular anatomy and associated intraoperational bleedingin laparoscopic right hemicolectomy in Department of Colorectal Surgery,the First Affiliated Hospital ofNanjing Medical University.Methods Videos of245cases who received laparoscopic right hemicolectomieswere collected and analyzed regarding to vascular anatomic relationship and intraoperational bleeding.Results The superior mesenteric artery and vein,ileocolic artery and vein,and middle colic artery werepresent in all cases.The right colic artery was present in22.9%(56/245)of the cases.Gastrocolic venoustrunk was present in most patients,227cases in245(92.7%).The overall intraoperational bleeding incidencewas19.2%(47/245).Artery related bleeding was observed in16cases(6.5%),among which parenchymahemorrhage of pancreas significantly prolonged laparoscopic operation time(t=2.895,P<0.05),while otherarterial hemorrhage did not prolong operation time(all P>0.05).Venous related bleeding was viewed in31cases(12.7%).Most of the venous related bleeding were the gastrocolic venous trunk,and its tributarieshad a higher risk of bleeding.Statistic analysis indicated that intraoperational bleeding significantly prolonged the overall operative time(P<0.05).Conclusions Vascular anatomy of right colon is complicated andvariable and laparoscopic right hemicolectomy has high risk of intraoperational hemorrhage.Understandinganatomic relationship of the right colon the vessels is critical to decrease and avoid bleeding.

关 键 词：结肠肿瘤 腹腔镜右半结肠癌根治术 胃结肠静脉干 术中出血 手术时间 

分 类 号：R735.35[医药卫生—肿瘤]