基于CT血管成像及图像融合技术的胃结肠静脉干的解剖学研究

目的 运用CT血管成像(CTA)及图像融合技术研究活体状态下胃结肠静脉干(GCT)解剖学特点。方法 回顾性分析南京医科大学附属无锡市第二医院2017年1月—2018年2月收治的80例术前诊断为胃癌、胰腺癌或右半结肠癌的患者的影像学资料,其中男46例、女34例,年龄39~83(68±10.1)岁。80例均行腹部CT平扫及增强扫描,将原始图像进行CTA和CT结肠成像(CTC)重建,并将图像融合,得到血管及肠道的三维图像。观测指标:(1)GCT的长度、管径、走行及其GCT的组成;(2)中结肠静脉汇入上级静脉的分布情况;(3)胰十二指肠上前静脉汇入上级静脉的分布情况。结果 (1)69例(86.25%)患者出现GCT,长度为2.5~25.2(9.2±3.6)mm;管径为3.3~7.2(4.8±0.9)mm。GCT均自腹侧至头侧向右走行,其属支共有右结肠静脉、中结肠静脉、胃网膜右静脉和胰十二指肠上前静脉4个来源。其中,35例(50.73%)由胃网膜右静脉和右结肠静脉、中结肠静脉构成“2支”型或“3支”型胃结肠干,7例(10.14%)由胃网膜右静脉和胰十二指肠上前静脉构成“2支”型胃胰干,27例(39.13%)由右结肠静脉、中结肠静脉、胃网膜右静脉和胰十二指肠上前静脉构成“3支”或“4支”型胃胰结肠干。(2)77例患者出现中结肠静脉,其中53例(68.83%)汇入肠系膜上静脉,20例(25.97%)汇入GCT,2例(2.60%)汇入肠系膜下静脉,2例(2.60%)汇入脾静脉。(3)46例(57.50%)胰十二指肠上前静脉直接汇入肠系膜上静脉;34例(42.50%)胰十二指肠上前静脉参与了GCT的组成,其中汇入胃网膜右静脉者12例,汇入右结肠静脉者10例,汇入胃网膜右静脉与右结肠静脉合干者7例,直接汇入GCT者5例。结论 CTA及图像融合技术可以直观地显示GCT血管解剖及变异,为临床腹部血管术前评估提供可靠的信息,具有较高的临床应用价值。

CT angiography and image fusion for anatomy of the gastric and colic trunk

Objective To study the anatomical characteristics of gastrocolic vein trunk(GCT) in vivo by using CT angiography (CTA) and image fusion. Methods From January 2017 to February 2018, 80 cases of abdominal CT plain scan and enhanced scan imaging data were analyzed retrospectively. In this study, there were 46 males and 34 females, aged 39-83(68±10.1) years. The original images were reconstructed by computed tomography angiography(CTA), computed tomography colonography(CTC) and fused to obtain three-dimensional images of blood vessels and intestines.Observation indexes included length, diameter and running of GCT, composition of GCT, distribution of the middle colon vein into the superior vein, distribution of superior venous confluence of anterior pancreaticoduodenal vein into superior vein. Results (1)Sixty-nine cases(86.25%) had GCT, the length was 2.5-25.2(9.2±3.6) mm, the average length was 3.3-7.2(4.8±0.9) mm. The trunk of the stomach and colon ran from the ventral to the right side. There were 4 origins of its branches: right colon vein, middle colon vein, right gastroepiploic vein and superior anterior pancreaticoduodenal vein. Among them, 35 cases(50.73%) consisted of right gastroepiploic vein, right colon vein and middle colon vein. In 7 cases(10.14%), the "2 branches" type of gastric and pancreatic trunk consisted of the right gastroduodenal vein and the anterior superior pancreaticoduodenal vein;27 cases(39.13%) consisted of right colon vein, middle colon vein, right gastroepiploic vein and superior anterior pancreaticoduodenal vein.(2)The middle colon veins were found in 77 patients. Among of them, the middle colon vein entered superior mesenteric vein in the 53 patients (68.83%), entered GCT in the 20 patiens (25.97%), entered inferior mesenteric vein in the 2 patiens (2.60%), and entered splenic vein in the 2 patiens(2.60%).(3)The superior anterior pancreaticoduodenal vein directly entered the superior mesenteric vein in 46 cases(57.50%), and the superior anterior pancreaticoduodenal vein participated in the composition of GCT in 34 cases(42.50%), including 12 cases of right gastroepiploic vein, 10 cases of right colon vein, 7 cases of right omental vein and right colon vein. Five cases were enrolled in GCT. Conclusions CTA and image fusion technology can visually display the anatomy and variation of GCT vessels, provide reliable information for preoperative evaluation of abdominal vessels, and have high clinical value.