中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2011年
4期
295-298
,共4页
胃肿瘤%肠系膜上动脉%肝动脉%淋巴转移
胃腫瘤%腸繫膜上動脈%肝動脈%淋巴轉移
위종류%장계막상동맥%간동맥%림파전이
Stomach neoplasms%Mesenteric artery,superior%Hepatic artery%Lymphatic metastasis
目的 对源自肠系膜上动脉的变异肝动脉走行情况进行分型,并检测变异肝动脉旁淋巴组织是否有转移,从而指导胃癌D2根治术.方法 对2008年1月至2010年6月间由同一术者进行胃癌D2根治术的86例胃癌患者的临床资料进行研究.患者术前均通过多层螺旋CT血管造影(MSCTA)对存在源自肠系膜上动脉变异肝动脉的走行情况进行分型,并经术中验证,术后将变异肝动脉旁淋巴组织行重组人细胞角蛋白20(CK20)、癌胚抗原(CEA)免疫组化作对照,从而判断异常动脉旁是否有淋巴结转移的发生.结果 本组源自肠系膜上动脉变异肝动脉14例,其中男12例、女2例,平均62岁,其中变异肝总动脉3例,变异肝右动脉11例,总变异率为16.3%,其中走行于胰腺前方的1例、胰腺后方的13例,术中清扫此变异肝动脉,尤其胰后型其难度较大,易损伤异常血管及胰腺,并且手术时间较正常肝动脉者明显延长[(218.8±23.9)min比(179.6±18.5)min],术前可通过MSCTA了解变异肝动脉的走行情况,从而指导术中的操作;胰前、后型异常血管旁淋巴组织的CK20、CEA免疫组化未发现淋巴结转移.结论 源自肠系膜上动脉的变异肝动脉走行分为胰前型和胰后型;建议在D2胃癌根治术中若发现此变异肝动脉存在时,可不做此血管周围组织清扫.
目的 對源自腸繫膜上動脈的變異肝動脈走行情況進行分型,併檢測變異肝動脈徬淋巴組織是否有轉移,從而指導胃癌D2根治術.方法 對2008年1月至2010年6月間由同一術者進行胃癌D2根治術的86例胃癌患者的臨床資料進行研究.患者術前均通過多層螺鏇CT血管造影(MSCTA)對存在源自腸繫膜上動脈變異肝動脈的走行情況進行分型,併經術中驗證,術後將變異肝動脈徬淋巴組織行重組人細胞角蛋白20(CK20)、癌胚抗原(CEA)免疫組化作對照,從而判斷異常動脈徬是否有淋巴結轉移的髮生.結果 本組源自腸繫膜上動脈變異肝動脈14例,其中男12例、女2例,平均62歲,其中變異肝總動脈3例,變異肝右動脈11例,總變異率為16.3%,其中走行于胰腺前方的1例、胰腺後方的13例,術中清掃此變異肝動脈,尤其胰後型其難度較大,易損傷異常血管及胰腺,併且手術時間較正常肝動脈者明顯延長[(218.8±23.9)min比(179.6±18.5)min],術前可通過MSCTA瞭解變異肝動脈的走行情況,從而指導術中的操作;胰前、後型異常血管徬淋巴組織的CK20、CEA免疫組化未髮現淋巴結轉移.結論 源自腸繫膜上動脈的變異肝動脈走行分為胰前型和胰後型;建議在D2胃癌根治術中若髮現此變異肝動脈存在時,可不做此血管週圍組織清掃.
목적 대원자장계막상동맥적변이간동맥주행정황진행분형,병검측변이간동맥방림파조직시부유전이,종이지도위암D2근치술.방법 대2008년1월지2010년6월간유동일술자진행위암D2근치술적86례위암환자적림상자료진행연구.환자술전균통과다층라선CT혈관조영(MSCTA)대존재원자장계막상동맥변이간동맥적주행정황진행분형,병경술중험증,술후장변이간동맥방림파조직행중조인세포각단백20(CK20)、암배항원(CEA)면역조화작대조,종이판단이상동맥방시부유림파결전이적발생.결과 본조원자장계막상동맥변이간동맥14례,기중남12례、녀2례,평균62세,기중변이간총동맥3례,변이간우동맥11례,총변이솔위16.3%,기중주행우이선전방적1례、이선후방적13례,술중청소차변이간동맥,우기이후형기난도교대,역손상이상혈관급이선,병차수술시간교정상간동맥자명현연장[(218.8±23.9)min비(179.6±18.5)min],술전가통과MSCTA료해변이간동맥적주행정황,종이지도술중적조작;이전、후형이상혈관방림파조직적CK20、CEA면역조화미발현림파결전이.결론 원자장계막상동맥적변이간동맥주행분위이전형화이후형;건의재D2위암근치술중약발현차변이간동맥존재시,가불주차혈관주위조직청소.
Objectives To classify the courses of the abnormal hepatic arteries originated from superior mesenteric artery in patients with gastric cancer, and to define its application in the D2 radical gastrectomy in those patients. Methods Eighty-six patients with gastric cancer who had received D2 radical gastrectomy by the same surgeon between January 2008 and June 2010 were included in this study. All patients received the preoperative multislice spiral computed tomoangiography (MSCTA) to classify the abnormal hepatic artery originated from the superior mesenteric artery, which was verified during the surgery. Postoperative immunohistochemistry of the lymphoid tissues around the abnormal hepatic artery was performed by recombinant human cytokeratin 20 (CK20) and carcino-embryonic antigen (CEA) to verify the micrometastasis. Results In this group, the abnormal hepatic artery originated from the superior mesenteric artery were found with MSCTA and verified by operation in 14 patients, including 12 men and 2women. The mean age was 62 years. Of the 14 cases with abnormal hepatic artery, 3 cases were found with abnormal common hepatic artery and 11 cases with abnormal right hepatic artery. The total mutation rate is 16. 3%. In those patients, the hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 13 cases. It was difficult to dissect the abnormal hepatic artery, especially for the post-pancreas type in D2lymphadenectomy, for fear of damaging the abnormal blood vessel and pancreas. The operation time in cases with abnormal hepatic artery was significantly longer than that in patients with normal hepatic artery [(218.8±23.9) min vs. (179. 6 ± 18. 5 ) min]. Immunohistochemical analysis revealed no metastasis in the lymphoid tissues surrounding the abnormal artery. Conclusions Abnormal hepatic arteries originated from the superior mesenteric artery can be classified into pre-pancreas type and post-pancreas type. The dissection of the abnormal hepatic artery is not advocated in D2 radical gastrectomy for no lymph node metastasis is found around the abnornal hepatic artery in this study.
