多层螺旋CT血管造影在胃癌规范性根治术术前评估中的价值

Preoperative Evaluation Value of Multislice Spiral Computed Tomography Angiography for Normative Radical Gastrectomy

目的探讨多层螺旋CT血管造影(multislice spiral computed tomography angiography,MSCTA)在胃癌规范性根治术术前评估中的价值。方法通过术前MSCTA了解86例胃癌患者腹腔干三大动脉分支及其属支(肝总动脉、肝右动脉、肝左动脉、脾动脉、胃左动脉)的解剖走行情况,并经术中验证;同时采用MSCTA对胃癌进行术前TNM分期,并将其与手术后病理结果进行对照。结果通过术中探查验证,86例患者术前MSCTA评估腹腔干三大动脉分支及其属支走行情况的准确率为100%。肝动脉解剖异常者22例,变异率为25.58%,其中异常肝右动脉11例(12.79%)、异常肝左动脉7例(8.14%)、同时存在异常肝左及异常肝右动脉1例(1.16%)、肝总动脉源自肠系膜上动脉3例(3.49%)。脾动脉直型24例(27.91%),轻曲型44例(51.16%),显著曲型18例(20.93%)。本组未发现胃左动脉变异情况。通过与术后病理对照,MSCTA对胃癌术前T、N、M分期的准确率分别为75.58%(65/86)、74.42%(64/86)和91.86%(79/86)。结论 MSCTA能较客观地评估胃癌患者术前腹腔干三大动脉分支及其属支的解剖走行情况及较为准确地进行胃癌术前TNM分期,在制定手术方案、防止术中动脉损伤等方面有着重要的作用。

Objective To explore the evaluation value of preoperattve multlshce spiral computed tomography angiography （MSCTA） for normative radical gastrectomy. Methods The anatomic distributions of celiac trunk and its three branches and their tributaries （common hepatic artery, right hepatic artery, left hepatic artery, splenic ar- tery, and left gastric artery） of 86 patients with gastric cancer were comprehended by preoperative MSCTA, which were verified during the surgery. Simultaneously preoperative TNM staging was evaluated by MSCTA, which com- pared with postoperative pathological results. Results The accuracy rate of preoperative MSCTA evaluating the dis- tribution of celiac trunk and its three branches and their tributaries was 100 %. Abnormal hepatic arteries were found in 22 cases by MSCTA, the mutation rate was 25. 58%. Abnormal right hepatic arteries were found in 11 cases （12.79%）, abnormal left hepatic arteries in 7 cases （8.14%）, both abnormal right and left hepatic arteries in 1 case （1.16%）, and abnormal common hepatic arteries in 3 cases （3.49%）. Straight splenic arteries were found in 24 cases （27.91% ）, slightly curved splenic arteries in 44 cases （51.16 % ）, and significantly curved splenic arteries in 18 cases （20.93 % ）. Compared with postoperative pathological results, the accuracy rates of preoperative MSCTA evaluating gastric cancer T, N, and M staging were 75.58% （65/86）, 74.42% （64/86）, and 91.86 % （79/86）, re-spectively. Conclusions Preoperative MSCTA is an objective way to assess the flis^rihutions of celiac artery trunk and related tributaries of patients with gastric cancer. Also, it is an accurate method to evaluate the preoperative TNM stage of gastric cancer, which can help to make an individual operative plan and avoid the intraoperative injury of the artery.