The Anatomical and Surgical Consequences of Right Colectomy for Cancer
The Anatomical and Surgical Consequences of Right Colectomy for Cancer
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右结肠切除术治疗癌症的解剖学和手术后果
DOI：
10.1097/dcr.0b013e318232116b
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发表时间：
2011
影响因子：
3.9
通讯作者：
D. Ignjatovic
中科院分区：
文献类型：
--
作者：
M. Spasojevic;B. Stimec;L. Grønvold;J. Nesgaard;B. Edwin;D. Ignjatovic
背景技术背景：目前的做法是在进行右半结肠切除术治疗癌症时，在上级肠系膜静脉的右侧分离右半结肠的供血血管。目的：本研究旨在通过术后早期CT显示动脉残端，并分析其解剖和手术特征。设计：本研究对前瞻性数据进行回顾性分析。环境：本研究在挪威Tonsberg的韦斯特福尔医院外科进行。病人：通过当地前瞻性并发症登记研究（FileMaker Pro 9.0v3软件）确定了癌症右结肠切除术后发生渗漏的患者（2003-2011年）。干预：对术前和术后CT进行检索、再分析和三维重建（Osirix v.3.0.2./ Mimics v.13.1.）。排除术后未行CT检查的患者。主要观察指标：测量的主要结果是假定和实际动脉残端的长度、口径及其相对于上级肠系膜静脉的位置。结果：18名患者，中位年龄69岁（10名男性）。所有患者均进行了术后CT检查，15例患者进行了术前CT检查。从手术到术后CT检查的中位时间为5天。14例（11对）患者发现回结肠动脉，5例（4对）患者发现右结肠动脉。实际残端长度分别为28.0 mm（SD 9.3）和37.3 mm（SD 14.9）。回结肠动脉残端长度的估计值与实际值之间存在显著的统计学差异（P = 0.002）。14支回结肠动脉中有8支与上级肠系膜上静脉后交叉，5支右结肠动脉中有3支与肠系膜上静脉后交叉。术前和术后右结肠动脉（P = .505）和回结肠动脉（P = .474）的平均口径无统计学差异。限制条件：通过与术前CT进行比较，克服了由于腹腔内积液、斯台普斯、水肿和血管结构改变导致的术后图像判读困难。结论：右半结肠癌切除术后早期CT可显示动脉残端。这些树桩似乎是显着长于假设，这意味着一个显着的改善潜力时，标本大小的关注。
BACKGROUND: Current practice when performing right colectomy for cancer is to divide the feeding vessels for the right colon on the right side of the superior mesenteric vein. OBJECTIVE: This study aims to show that arterial stumps can be visualized through an early postoperative CT and analyze their anatomical and surgical characteristics. DESIGN: This study presents a retrospective review of prospective data. SETTINGS: The study was conducted at the Department of Surgery, Vestfold Hospital, Tonsberg, Norway. PATIENTS: Patients with leakage after a right colectomy for cancer (2003–2011) were identified through a local prospective complication registry (FileMaker Pro 9.0v3 software). INTERVENTIONS: Both preoperative and postoperative CTs were retrieved, reanalyzed, and 3-dimensionally reconstructed (Osirix v.3.0.2./Mimics v.13.1.). Patients without postoperative CTs were excluded. MAIN OUTCOME MEASURES: The main outcomes measured were length, caliber of presumed and actual arterial stumps, and their position relative to the superior mesenteric vein. RESULTS: Eighteen patients, median age 69 (10 men) were included. All patients had postoperative CTs, and 15 patients had preoperative CTs. Median time from operation to postoperative CT was 5 days. The ileocolic artery was found in 14 (11 CT pairs) patients, and the right colic artery was found in 5 (4 pairs) patients. Actual stump lengths were 28.0 mm (SD 9.3) and 37.3 mm (SD 14.9). A significant statistical difference between presumed and actual ileocolic artery stump lengths was found (P = .002). Posterior crossing to the superior mesenteric vein was noticed in 8 of 14 ileocolic arteries and in 3 of 5 right colic arteries. There was no statistical difference in mean caliber for the preoperative and postoperative right colic artery (P = .505) and ileocolic artery (P = .474). LIMITATIONS: Difficulties when interpreting the postoperative images, due to intra-abdominal effusion, staples, edema, and altered syntopy of blood vessels, were overcome through comparison with preoperative CTs. CONCLUSION: An early postoperative CT can show arterial stumps after right colectomy for cancer. These stumps appear to be significantly longer than presumed; implying a significant improvement potential when specimen size is concerned.