腹腔镜下迷走神经后干及其属支临床解剖研究

Surgical anatomy of the posterior vagus trunk and its distributaries in laparoscopic surgery

目的观察、测量并分析腹腔镜手术迷走神经后干及其属支与胃左动脉的解剖关系。方法选择2017-11-13至2018-11-16大连医科大学附属第一医院胃肠外科行腹腔镜保留胃功能的胃切除术41例胃癌病人;腹腔镜下观察迷走神经后干及其属支与胃左动脉关系;并进行分型。测量迷走神经后干、腹腔支的长度以及神经与胃左动脉共干长度、胃左动脉长度。结果迷走神经后干、腹腔支、胃支出现率为100%。迷走神经后干及其属支与胃左动脉关系分型:紧密型9例(22.0%)、中间型25例(61.0%)、游离型7例(17.0%)。远端切缘为(2.7±1.0)cm;近端切缘为(4.9±2.6)cm;胃左动脉长度为(4.0±0.6)cm;迷走神经后干长度为(5.1±1.2)cm;腹腔支长度为(4.2±0.6)cm;神经与胃左动脉共干长度为(2.1±0.9)cm。结论充分了解迷走神经后干及其属支与胃左动脉的解剖关系对完成腹腔镜下保留幽门及迷走神经胃部分切除术有重要指导意义。

Objective To study surgical anatomy of the posterior vagus trunk and its distributaries and the relationship with the left gastric artery in laparoscopic gastrectomy. Methods The prospective observational trial included 41 patients performed laparoscopic vagus nerve-preserving gastrectomy admitted between November 13;2017 and November 16;2018 in Department of Gastrointestinal Surgery;the First Affiliated Hospital;Dalian Medical University. The classification of the relationship between the posterior vagal trunk and the left gastric artery was determined in laparoscopic surgery. The length of posterior vagal trunk;celiac branch;the parallel part of nerve and left gastric artery;and the length of left gastric artery were measured. Results The probability of posterior vagus trunk;celiac branch and gastric branch was 100%. The relationship between the posterior vagus trunk and the left gastric artery can be divided into three type about compact type 9 cases (22.0%);intermediate type 25 cases(61.0%) and free type 7 cases(17.0%). The distal margin;proximal margin;length of left gastric artery;posterior vagal trunk;celiac branch and the parallel part of nerve and vessel were(2.7±1.0)cm;(4.9±2.6)cm;(4.0±0.6)cm;(5.1±1.2)cm;(4.2±0.6)cm and (2.1±0.9)cm respectively. Conclusion Getting familiar with the anatomy of the posterior vagus trunk and its distributaries and the relationship with the left gastric artery would be helpful to laparoscopic pylorus and vagus nerve-preserving gastrectomy.