多层螺旋CT血管成像对腹腔镜辅助下胃切除术的价值

目的探讨腹腔镜辅助下胃切除术前多层螺旋CT血管造影（MSCTA），评价胃周血管解剖中的价值。方法30例拟行腹腔镜辅助下胃远端切除术的患者行多层螺旋CT双期扫描，其动、静脉期图像采用容积再现重建技术分别行三维CT血管造影（CTA）。3位观察者根据其CT血管成像表现，评价胃左动脉、胃右动脉、替代肝左动脉以及胃左静脉解剖，其结果与手术对照。结果三维CTA准确显示胃左动脉30例、胃右动脉29例，胃左静脉30例。1例胃右动脉CTA未能发现，但术中发现其管径细小。6例患者CTA发现伴有替代肝左动脉。根据三维CTA制定手术方案，所有30例患者腹腔镜辅助下胃远端切除术均获得成功。以手术结果为对照，CTA显示胃左动脉、胃左静脉和替代肝左动脉敏感性和阳性预测值均为100％；显示胃右动脉敏感性为100％，阳性预测值为96％。结论MSCTA能够准确评价胃的血管解剖，有利于安全快速进行腹腔镜辅助下胃远端切除术。

Value of multi-slice CT angiography in preoperative assessment of vascular anatomy around stomach before laparoscopy-assisted gastrectomy

Objective To evaluate the efficacy of MSCTA in the preoperative assessment of the vascular anatomy around the stomach before laparoscopy-assisted gastrectomy. Methods A total of 30 consecutive patients scheduled for laparoscopy- assisted distal gastrectomy were evaluated on MSCT. CT was performed at the arterial phase after a bolus IV injection of contrast material. Three-dimensional CT angiography (3DCTA) of the arterial and venous systems was reconstructed separately using a volume-rendering algorithm, and the images were fused. Thsee-dimensional CTA for the left gastric, right gastric, and replaced left hepatic arteries and the left gastric vein was evaluated prospectively by three reviewers, and then a surgical correlation was made. Results In all 30 cases, the left gastric artery was correctly identified on 3D CTA. In 29 of 30 cases, the right gastric artery was correctly identified, whereas in one case, the right gastric artery could not be visualized on 3D CTA because of its small size. The left gastric vein was correctly identified 1n all 30 cases, while the replaced left hepatic artery was correctly identified on 3D CTA in six cases. All 30 cases underwent successful laparoscopy-assisted distal gastrectomy on the basis of the 3D CTA. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct determination of the left gastric artery, replaced left hepatic artery, and left gastric vein. The sensitivity and positive predictive values for the right gastric artery were 100% and 96%, respectively. Conclusion Three-dimensional CTA using MSCT clearly reveals individual vascular anatomies around the stomach.It will play an important role in safely facilitating the laparoscopy-assisted gastrectomy procedure.