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目的 探讨多层螺旋CT血管成像在分析右半结肠血管解剖变异和结构分型中的应用价值.方法 回顾性收集2015年8月至2017年8月198例北京大学第一医院普通外科住院治疗患者(其中96例患者行腹腔镜右半结肠癌根治术)的腹部CT增强扫描结果,并进行血管三维重建.男性104例,女性94例,年龄64(27)岁[M(QR),范围:19~87岁].分别记录胃网膜右静脉、胰十二指肠前上静脉、右结肠静脉、副右结肠静脉、回结肠动静脉、中结肠动静脉、Henle干及肠系膜上动静脉之间的相互位置关系,并测量Henle干及外科干的长度.结果 回结肠静脉和回结肠动脉是最恒定的解剖结构,均直接来自肠系膜上动静脉,36.9%(73/198)的回结肠动脉走行于肠系膜上静脉前方,63.1% (125/198)走行于肠系膜上静脉后方.72.2%(143/198)患者的右结肠静脉汇入Henle干,27.8% (55/198)汇入肠系膜上静脉.81.3%(161/198)的患者存在中结肠静脉,其中81.4%(131/161)汇入肠系膜上静脉,16.8%(27/161)汇入Henle干,1.2%(2/161)汇入第一空肠静脉,0.6%(1/161)汇入脾静脉.Henle干分为4型,其中胃结胰干出现概率最高.Henle干长度为(0.82±0.39)cm(范围:0.37~1.68 cm).外科干长度为(2.54±0.83)cm(范围:1.57~3.95 cm).与术中观察情况相比,CT血管成像分析准确率为96.9%(93/96).结论 右半结肠血管解剖变异复杂.腹部CT血管成像技术有助于体现右半结肠血管解剖结构.

Objectives To examine the value of multi-slice spiral CT angiography (MSCTA) in the analysis of anatomical variation and structural classification of right colon vessels. Methods From August 2015 to August 2017, 198 patients (96 of whom underwent laparoscopic radical resection of right colon cancer) at Department of General surgery of Peking University First Hospital were retrospectively collected, and the results of abdominal enhanced CT scan were collected and three-dimensional reconstruction of blood vessels was performed. There were 104 males and 94 females. The age was 64(27) years (M(QR), range: 19 to 87 years). Right gastroepiploic vein, anterior superior pancreaticoduodenal vein, right colonic vein (RCV), superior right colonic vein, ileocolon artery or vein (ICA or ICV), middle colon artery or vein (MCA or MCV) and Henle trunk were observed and recorded respectively. The anatomical relationship between the positions of blood vessels, the length of Henle trunk and surgical trunk were measured. Results ICV and ICA were the most constant anatomic structures. The ICV/ICA of all patients came directly from SMV/SMA, 36.9% (73/198) ICV going in front of SMV and 63.1% (125/198) behind SMV. 72.2% (143/198) of the patients had RCV imported into Henle trunk and the rest into SMV. Middle colonic vein (MCV) could be observed in 81.3% (161/198) of the cases. 81.4% (131/161) of MCV were imported into SMV, 16.8% (27/161) into Henle trunk, 1.2% (2/161) into the first jejunal vein and 0.6% (1/161) into the splenic vein. Henle trunk was divided into 4 types, among which the occurrence probability of gastric node and pancreatic trunk was the highest. The dry length of Henle trunk was (0.82 ± 0.39) cm (range: 0.37 to 1.68 cm). The length of surgical trunk was (2.54±0.83) cm (range: 1.57 to 3.95 cm). Accuracy of MSCTA results was 96.9%(93/96). Conclusions Anatomical variation of blood vessels in the right colon is common. Abdominal CT angiography can accurately determine the anatomical structure of the blood vessels in the right colon.