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目的探讨多层螺旋CT血管造影(multislice spiral computed tomography angiography,MSCTA)在胃癌规范性根治术术前评估中的价值。方法通过术前MSCTA了解86例胃癌患者腹腔干三大动脉分支及其属支(肝总动脉、肝右动脉、肝左动脉、脾动脉、胃左动脉)的解剖走行情况,并经术中验证;同时采用MSCTA对胃癌进行术前TNM分期,并将其与手术后病理结果进行对照。结果通过术中探查验证,86例患者术前MSCTA评估腹腔干三大动脉分支及其属支走行情况的准确率为100%。肝动脉解剖异常者22例,变异率为25.58%,其中异常肝右动脉11例(12.79%)、异常肝左动脉7例(8.14%)、同时存在异常肝左及异常肝右动脉1例(1.16%)、肝总动脉源自肠系膜上动脉3例(3.49%)。脾动脉直型24例(27.91%),轻曲型44例(51.16%),显著曲型18例(20.93%)。本组未发现胃左动脉变异情况。通过与术后病理对照,MSCTA对胃癌术前T、N、M分期的准确率分别为75.58%(65/86)、74.42%(64/86)和91.86%(79/86)。结论 MSCTA能较客观地评估胃癌患者术前腹腔干三大动脉分支及其属支的解剖走行情况及较为准确地进行胃癌术前TNM分期,在制定手术方案、防止术中动脉损伤等方面有着重要的作用。
Objective To investigate the value of multislice spiral computed tomography angiography (MSCTA) in the preoperative evaluation of radical gastrectomy for gastric cancer. Methods The anatomical characteristics of the branches of the celiac arteries and their branches (common hepatic artery, right hepatic artery, left hepatic artery, splenic artery and left gastric artery) of 86 patients with gastric cancer were studied by MSCTA before operation. At the same time, preoperative TNM staging was performed on gastric cancer with MSCTA, and compared with postoperative pathological results. Results The intraoperative exploration proved that the accuracy of preoperative MSCTA in 86 patients for assessing the cadaveric branches and their branches was 100%. There were 22 cases with abnormal hepatic artery anatomy, the rate of variation was 25.58%, including 11 cases of abnormal right hepatic artery (12.79%), 7 cases of abnormal left hepatic artery (8.14%), 1 case of abnormal left hepatic artery and right hepatic artery 1.16%). The common hepatic artery originated from the superior mesenteric artery in 3 cases (3.49%). There were 24 cases (27.91%) of splenic artery straight type, 44 cases (51.16%) of mild type and 18 cases (20.93%) of significant curve. This group did not find the variation of gastric left artery. The accuracy of MSCTA for preoperative T, N, M staging of gastric cancer was 75.58% (65/86), 74.42% (64/86) and 91.86% (79/86), respectively. Conclusion MSCTA can objectively evaluate the anatomy of the branches and their branches of the celiac trunk arteries of patients with gastric cancer and accurately determine the preoperative TNM stage of gastric cancer. It is of great importance in the development of surgical plans and prevention of intraoperative arterial injury effect.