术前多层螺旋CT血管成像检查对胃癌根治术的指导价值

目的 探讨术前行腹部多层螺旋CT血管成像（MSCTA）检查在胃癌根治术中的临床意义.方法 将103例胃癌患者,根据本人意愿分成术前行MSCTA检查组57例（Ⅰ组）和未行MSCTA检查组46例（Ⅱ组）,由同一组术者进行手术.结果 Ⅰ组患者经MSCTA检查,发现有6例（10.5%）供胃血管发生变异 全组患者胃周主要血管的位置、走向及与病变的关系术中所见与MSCTA检查诊断符合率为100% Ⅰ组的手术时间[（206±23）min]比Ⅱ组[（257±32）min]短（95%CI：-22.452～-0.919,P=0.044） Ⅰ组供胃动脉解剖异常患者的手术时间[（190±50）min]比Ⅱ组术中发现异常的3例患者手术时间[（255±62）min]短（95%CI：-100.141～-3.193,P=0.048）.而两组病例（包括供胃动脉解剖异常者）术中平均出血量、淋巴结清扫量、并发症发生率、术后住院天数、住院费用比较,差异无统计学意义（均P＞0.05）.结论 术前行MSCTA检查,对评估肿瘤血管及周围组织结构、防止因缺乏了解而误伤变异血管或组织器官可提供一定的保障.

Clinical significance of multi-slice spiral CT angiography in radical resection of gastric cancer

Objectives To explore the clinical significance of preoperative abdominal multislice spiral CT angiography (MSCTA) in radical resection of gastric cancer. Methods One hundred and three patients with gastric cancer were divided into two groups according to their desires. Group Ⅰ included 57 patients who underwent preoperative MSCTA and group Ⅱ included 46 patients who underwent surgery without preoperative MSCTA. All these patients were operated by the same surgical team. Results Six patients (10.5%) with abnormal gastric artery in group Ⅰ were discovered. The diagnostic concordance rate between MSCTA and intraoperative findings was 100% in group Ⅰ in the locations and alignments of main perigastric vessels and their relationship with cancer lesions.Operative time in group Ⅰ was shorter than that in group Ⅱ [(206±23)min vs. (257±32)min, P=0.044]. Operative time [(190±50) min] of patients with abnormal gastric artery of group Ⅰ was shorter than that [(255±62) min] of patients with abnormal gastric artery discovered during operation of group Ⅱ (P=0.048). However there were no differences in blood loss, extent of lymph node dissection,complication rate, length of hospital stay, and hospitalization cost between the two groups (P＞0.05).Conclusion Preoperative MSCTA is beneficial to the evaluation of vascular structure of the cancer and the adjacent tissues, which may reduce postoperative complications.