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中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (06) : 478 -483. doi: 10.3877/cma.j.issn.2095-3224.2017.06.007

所属专题: 文献

论著

腹腔镜下右侧结肠血管解剖学观察及术中出血的临床分析
封益飞1, 吉冰1, 张悦1, 季东健1, 张冬生1, 胥子玮1, 王勇1, 傅赞1, 孙跃明1,()   
  1. 1. 210029,南京医科大学第一附属医院结直肠外科
  • 收稿日期:2017-07-16 出版日期:2017-12-25
  • 通信作者: 孙跃明
  • 基金资助:
    教育部基金项目(No.2012YQ030261); 江苏省科技厅基础研究计划(No.BK20131448)

Vascular anatomy of the right colon and intraoperational bleeding during laparascopic surgery

Yifei Feng1, Bin Ji1, Yue Zhang1, Dongjian Ji1, Dongsheng Zhang1, Ziwei Xu1, Yong Wang1, Zan Fu1, Yueming Sun1,()   

  1. 1. Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2017-07-16 Published:2017-12-25
  • Corresponding author: Yueming Sun
  • About author:
    Corresponding author: Sun Yueming, Email:
引用本文:

封益飞, 吉冰, 张悦, 季东健, 张冬生, 胥子玮, 王勇, 傅赞, 孙跃明. 腹腔镜下右侧结肠血管解剖学观察及术中出血的临床分析[J/OL]. 中华结直肠疾病电子杂志, 2017, 06(06): 478-483.

Yifei Feng, Bin Ji, Yue Zhang, Dongjian Ji, Dongsheng Zhang, Ziwei Xu, Yong Wang, Zan Fu, Yueming Sun. Vascular anatomy of the right colon and intraoperational bleeding during laparascopic surgery[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(06): 478-483.

目的

探讨腹腔镜下右侧结肠的血管解剖关系并分析不同血管出血的临床特征。

方法

采集2014年12月至2016年12月间南京医科大学第一附属医院结直肠外科完成的245例腹腔镜右半结肠癌根治术的手术录像,分析右侧结肠血管的解剖关系及其对手术进程的影响。

结果

肠系膜上动静脉、回结肠动静脉出现几率均是100%。回结肠动脉位于静脉后方者更多见,共142例(58.0%)。右结肠动脉独立发自肠系膜上动脉者56例(22.9%),均经肠系膜上静脉前方跨过。本组病例中227例患者(92.7%)存在胃结肠静脉干(Henle氏干)。其中以胃网膜右静脉和右结肠静脉形成的胃结肠干(33.9%)以及胃网膜右静脉、右结肠静脉和胰十二指肠前静脉汇合成的胃胰结肠干(34.7%)最多见。本研究中出现术中出血47例,占总病例数的19.2%。其中动脉性出血16例(6.5%),胰腺实质出血会明显延长腹腔镜手术时间(t=2.895,P<0.05),而其他动脉性出血并不会延长手术时间(均P>0.05)。静脉性出血31例患者 (12.7%),大部分为胃结肠静脉干属支出血。统计结果显示,术中出现静脉出血并发症均会延长手术时间(P<0.05)。

结论

右侧结肠血管解剖变异较多,术中血管出血概率较高,以静脉出血多见且较难处理,明显延长腹腔镜手术时间。深刻理解腹腔镜下右半结肠血管的解剖关系,尤其是胃结肠静脉干的解剖有利于减少术中出血的发生。

Objective

To summarize vascular anatomy and associated intraoperational bleeding in laparoscopic right hemicolectomy in Department of Colorectal Surgery, the First Affiliated Hospital of Nanjing Medical University.

Methods

Videos of 245 cases who received laparoscopic right hemicolectomies were collected and analyzed regarding to vascular anatomic relationship and intraoperational bleeding.

Results

The superior mesenteric artery and vein, ileocolic artery and vein, and middle colic artery were present in all cases. The right colic artery was present in 22.9% (56/245) of the cases. Gastrocolic venous trunk was present in most patients, 227 cases in 245 (92.7%). The overall intraoperational bleeding incidence was 19.2% (47/245). Artery related bleeding was observed in 16 cases (6.5%), among which parenchyma hemorrhage of pancreas significantly prolonged laparoscopic operation time (t=2.895, P<0.05), while other arterial hemorrhage did not prolong operation time (all P>0.05). Venous related bleeding was viewed in 31 cases (12.7%). Most of the venous related bleeding were the gastrocolic venous trunk, and its tributaries had a higher risk of bleeding. Statistic analysis indicated that intraoperational bleeding significantly prolonged the overall operative time (P<0.05).

Conclusions

Vascular anatomy of right colon is complicated and variable and laparoscopic right hemicolectomy has high risk of intraoperational hemorrhage. Understanding anatomic relationship of the right colon the vessels is critical to decrease and avoid bleeding.

图1 回结肠动静脉的位置关系。A:ICA位于ICV正前方;B:ICA位于ICV前上;C:ICA位于ICV前下方;D:ICA位于ICV正后;E:ICA位于ICV后上;F:ICA位于ICV后下方。(ICA:回结肠动脉;ICV:回结肠静脉;RCA:右结肠动脉;MCV:中结肠静脉;SMV:肠系膜上静脉;SMA:肠系膜上动脉;DUO:十二指肠;PAN:胰腺)
图2 右结肠动脉和中结肠动脉的关系。A:右结肠动脉单独发自肠系膜上动脉;B:右结肠动脉缺如,中结肠动脉两个分支;C:中结肠动脉三个分支。(ICA:回结肠动脉;ICV:回结肠静脉;RCA:右结肠动脉;MCA:中结肠动脉;SMV:肠系膜上静脉;SMA:肠系膜上动脉)
图3 胃结肠静脉干构成。A:无静脉干;B:GCT(RCV/RGEV;C:GPT(RGEV/ASPDV);D:GCT(RCV/MCV/RGEV);E:GPCT(RCV/RGEV/ASPDV);F:GPCT(2RCV/RGEV/ASPDV)。RCV:右结肠静脉,MCV:中结肠静脉,RGEV:胃网膜右静脉,ASPDV:胰十二指肠上前静脉,GCT:胃结肠静脉干,GPT:胃胰静脉干,GPCT:胃胰结肠静脉干
表1 胃结肠静脉干构成比例
表2 术中常见部位动脉性出血情况
表3 术中出现动脉出血延长腹腔镜手术时间的情况
表4 术中出现静脉血管并发症的血管例数及并发症情况
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