多层螺旋CT血管造影技术在腹腔镜右半结肠手术前评估中的作用

Multi-slice spiral computed tomography angiography for preoperative evaluation of laparascopic right hemicolectomy

目的探讨多层螺旋CT血管造影技术（MSCTA）在腹腔镜右半结肠手术前评估中的应用价值。方法收集160例（A组）普通患者行腹部螺旋CT扫描得到的断层图像，在工作站以容积再现的方法进行三维重建．并对其动脉期重建图像中肠系膜上动脉（SMA）主要分支数量及走行方向进行解读并进行解剖分型。另选取45例（B组）拟行腹腔镜右半结肠手术患者，术前予以MSCTA检查．分别对其肝动脉期与门脉期得到的重建图像进行原位融合．分析回结肠动脉与回结肠静脉走行的关系．并将其术前重建图像与术中实际所见进行对比。结果A组160例患者中有70例（43．8％）存在不同程度的解剖变异，其中51例（31．9％）存在2支右结肠动脉，14例（8．8％）存在2支结肠中动脉。术前MSCTA显示。B组45例患者中有13例（28．9％）回结肠动脉走行于回结肠静脉的腹侧．32例（71．1％）走行于回结肠静脉的背侧：与术中裸化血管后实际观察到的情况比较，走行情况吻合率为100％。结论由于肠系膜上动脉解剖变异普遍存在．腹腔镜右半结肠手术前行多层螺旋CT检查能够对术中操作起到有效的指导性评估作用。

Objective To explore the application value of multi-slice spiral CT angiography （MSCTA） for the preoperative evaluation of laparaseopic right hemicolectomy. Methods Abdominal CT slice images of 160 patients （group A） were collected for 3-dimensional reconstruction using volume rendering technique. Interpretation and anatomical classification of the major branches and course of the superior mesenteric artery （SMA） in the reconstructed images of the arterial phase were carried out. Forty-five patients （group B） undergoing laparoscopic right hemicolectomy were evaluated with MSCT combining images obtained from the arterial phase and portal venous phase. The relationship between ileocolic artery and ileocolic vein was analyzed. The preoperative imaging findings were compared to that revealed during the procedure. Results In group A, 70（43.8%） out of 160 patents showed anatomical variations of the superior mesenteric artery, of whom 51（31.9%） had two right colic arteries, and 14 （8.8%）had two middle colic arteries. Preoperative MSCTA showed that in group B ileocolic artery was running ventrally to ileocolic vein in 13 （28.9%） out of 45 patients, while running dorsally in 32 （71.1%）. Compared to the skeletonized vessels during the procedure, the consistency rate was 100%. Conclusion Anatomical variations of superior mesenteric artery are common, therefore, multi- slice spiral CT scan is vital for preoperation evaluation.