基于容积CT增强扫描的胃结肠静脉干解剖学研究

目的 探讨容积CT增强扫描观察活体状态下胃结肠静脉干及其属支的解剖学特点。方法 回顾性分析2014年9月—2016年8月首都医科大学大兴教学医院行腹部增强CT检查的124例患者的临床资料,其中,男57例、女67例,年龄19~75岁,平均50.5岁。所有受检者行腹部CT三期增强扫描,容积重建门静脉期图像。观察胃结肠静脉干位置、走行,测量胃结肠静脉干长度、管径;观察胃结肠静脉干各属支的分型、走行以及胰十二指肠上前静脉的汇入点;参照国内动脉血管显示效果评价标准对各属支血管显示效果进行评级。结果 124例患者中,117例(94.3%)形成胃结肠静脉干。胃结肠静脉干位于横结肠系膜内,紧贴胰头前缘走行,均于胰头下缘汇入肠系膜上静脉。其中,胃结肠静脉干向肠系膜上静脉右侧走行者占61.54%(72/117),右前方走行者占36.75%(43/117),前方和右上方走行者各占0.85%(1/117);胃结肠静脉干长度为2.6～21.9 mm,平均(8.6±3.7 )mm;管径为3.2～7.0 mm,平均(5.1±0.9)mm;胃结肠静脉干属支中胃结肠干型16例、胃胰干型23例、胃胰结肠干型78例。124例中显示胰十二指肠上前静脉101例,其中汇入胃网膜右静脉40例,汇入右结肠静脉43例,汇入胃网膜右静脉与右结肠静脉合干4例,直接汇入胃结肠静脉干14例。胃结肠静脉干各属支血管显示效果评定:胃网膜右静脉、右结肠静脉、中结肠静脉显示效果均达到3级,胰十二指肠上前静脉显示效果1级33例、2级61例、3级7例。结论 容积增强CT能够在活体状态下较清晰显示胃结肠静脉干的解剖细节,对于临床手术有重要指导价值。

Anatomical features of the gastrocolic venous trunk based on enhanced volume CT

Objective To observe the anatomical features of the gastrocolic venous trunk (GVT) and its branches in vivo using enhanced volume CT. Methods The clinical data of 124 patients who underwent the enhanced CT scan of abdomen in Daxing Hospital of Capital Medical University from September 2014 to August 2016 were retrospectively reviewed. Among them, there were 75 males and 67 females, ranging from 19 to 75 years old, with the mean age of 50.5 years. All subjects underwent three-phase enhanced scanning for abdomen, and portal-venous phase images were reconstructed by volume rendering to observe the anatomical features of the gastrocolic trunk and its branches. And finally, the display effect of images were scored according to the evaluation criteria of domestic arterial blood vessel display. Results Among 124 patients, GVT was visible in 117 patients (94.3%), and the GVT was located in the transverse mesocolon, closely walking along the front of the head of pancreas, and it drained into the superior mesenteric vein (SMV) in the lower edge of the head of pancreas. It ran the right side of SMV in 72 patients (61.54%), on the right front side in 43 (36.75%) and on the front side and on the upper right side of SMV in 1 patient(0.85%) respectively. The length of the gastrocolic vein trunk ranged from 2.6 to 21.9 mm and the mean was (8.6±3.7) mm, while its diameter ranged from 3.2 to 7.0 mm and the mean was (5.1±0.9) mm. In 117 patients with venous trunk, the gastrocolic trunk (GCT), gastropancreatic trunk (GPT) and gastropancreaticocolic trunk (GPCT) were found in 16, 23, 78 patients respectively. Anterior superior pancreaticoduodenal vein (ASPDV) presented in 101 patients, and it drained into the right gastroepiploic vein (RGeV) in 40 patients, into the right colic vein (RCV) in 43 patients, into the common trunk of RGeV and RCV in 4 patients, and into the GVT in 14 patients accordingly. The score of the display effect of GTV branches was as follows: the display effect of RGeV, RCV, MCV reached up to 3 points, and the display effect of ASPDV reached up to 1 point in 33 patients, 2 points in 61 patients and 3 points in 7 patients. Conclusions Enhanced volume CT can clearly show the space anatomical characteristics of the gastrocolic vein trunk in vivo, meanwhile it has important guiding value for clinical procedures.