胃癌患者手术前胃左动脉的CT三维血管重建检查

Preoperative evaluation of left gastric artery by 64-slice spiral CT angiography in gastric cancer patients

目的 术前了解胃癌患者胃左动脉的解剖,指导术中N07组淋巴结的清扫.方法 利用64排螺旋CT三维血管重建技术在术前检查胃癌患者胃左动脉的起始位置.结果 本组共观察731例.胃左动脉起于腹腔动脉干者635例,其中起于肝总动脉和脾动脉分支处者176例,起于腹腔干前1/3者292例,起于中1/3者135例,起于后1/3者32例.起于其他地方者共78例,其中起于腹腔干与腹主动脉夹角处者9例,起于腹主动脉者28例,起于胃脾动脉干者27例,起于脾动脉者4例,起于肝总动脉者4例,起于肝左动脉者1例,起于肝胃动脉干者4例,起于肠系膜上动脉者1例.15例胃左动脉缺如.3例特殊变异.结论 术前掌握胃癌患者胃左动脉起始位置及变异情况对顺利清扫其周围淋巴结,避免血管损伤有重要意义.

Objective To delineate the anatomy of left gastric artery （LGA） by CT imaging before radical gastrectomy in gastric cancer patients to facilitate intraoperative N07 lymph node dissection.Methods Preoperative 64 spiral CT angiography （CTA） was applied to observe the origin and course of LGA in gastric cancer patients. Results There were 731 gastric cancer patients undergoing preoperative image evaluation with LGA origin identified from celiac axis in 635 cases. Among those, LGA originated respectively at the crotch of splenic artery and common hepatic artery in 176 cases, from the proximal 1/3 in 292 cases, middle 1/3 in 135 cases and distal 1/3 in 32 cases. There were 9, 28, 27, 4, 4, 1, 4 and 1 cases in whom LGA originates respectively at the angle between celiac trunk and abdominal aorta, from the abdominal aorta, arteria gastrolienalis, splenic artery, common hepatic artery, left hepatic artery, artery gastrohepatica and superior mensentaric artery. LGA has not been observed in 15 cases and the origination of LGA could not be delineated in 3 cases. Conclusions Being familiar with the anatomy of LGA as visualized by preoperative CTA in gastric cancer patient, facilitates lymph node dissection around the LGA and decreases iatrogenic injury to vital blood vessels.