• 廣西醫(yī)科大學(xué)第一附屬醫(yī)院胃腸外科(廣西南寧 530021);

目的探討多層螺旋CT血管造影(multislice spiral computed tomography angiography，MSCTA)在胃癌規(guī)范性根治術(shù)術(shù)前評(píng)估中的價(jià)值。方法通過(guò)術(shù)前MSCTA了解86例胃癌患者腹腔干三大動(dòng)脈分支及其屬支(肝總動(dòng)脈、肝右動(dòng)脈、肝左動(dòng)脈、脾動(dòng)脈、胃左動(dòng)脈)的解剖走行情況，并經(jīng)術(shù)中驗(yàn)證; 同時(shí)采用MSCTA對(duì)胃癌進(jìn)行術(shù)前TNM分期，并將其與手術(shù)后病理結(jié)果進(jìn)行對(duì)照。結(jié)果通過(guò)術(shù)中探查驗(yàn)證，86例患者術(shù)前MSCTA評(píng)估腹腔干三大動(dòng)脈分支及其屬支走行情況的準(zhǔn)確率為100%。肝動(dòng)脈解剖異常者22例，變異率為25.58%，其中異常肝右動(dòng)脈11例(12.79%)、異常肝左動(dòng)脈7例(8.14%)、同時(shí)存在異常肝左及異常肝右動(dòng)脈1例(1.16%)、肝總動(dòng)脈源自腸系膜上動(dòng)脈3例(3.49%)。脾動(dòng)脈直型24例(27.91%)，輕曲型44例(51.16%)，顯著曲型18例(20.93%)。本組未發(fā)現(xiàn)胃左動(dòng)脈變異情況。通過(guò)與術(shù)后病理對(duì)照，MSCTA對(duì)胃癌術(shù)前T、N、M分期的準(zhǔn)確率分別為75.58%(65/86)、74.42%(64/86)和91.86%(79/86)。結(jié)論MSCTA能較客觀地評(píng)估胃癌患者術(shù)前腹腔干三大動(dòng)脈分支及其屬支的解剖走行情況及較為準(zhǔn)確地進(jìn)行胃癌術(shù)前TNM分期，在制定手術(shù)方案、防止術(shù)中動(dòng)脈損傷等方面有著重要的作用。

引用本文： 劉超,黃源,林進(jìn)令. 多層螺旋CT血管造影在胃癌規(guī)范性根治術(shù)術(shù)前評(píng)估中的價(jià)值. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(4): 441-445. doi: 復(fù)制

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8. Winter TC 3rd, Freeny PC, Nghiem HV, et al. Hepatic arterial anatomy in transplantation candidates: evaluation with threedimensional CT arteriography [J]. Radiology, 1995, 95(2): 363370.
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14. Napieralski R, Ott K, Kremer M, et al. Methylation of tumorrelated genes in neoadjuvanttreated gastric cancer: relation to therapy response and clinicopathologic and molecular features [J]. Clin Cancer Res, 2007, 13(17): 50955102.
15. Roth AD, Fazio N, Stupp R, et al. Docetaxel, cisplatin, and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase Ⅱ trial of the Swiss Group for Clinical Cancer Research [J]. J Clin Oncol, 2007, 5(22): 32173223.
16. Lee IJ, Lee JM, Kim SH, et al. Helical CT evaluation of the preoperative staging of gastric cancer in the remnant stomach [J]. AJR Am J Roentgenol, 2009, 192(4): 902908.
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21. 高劍波, 郭華, 楊學(xué)華, 等. 胃癌TNM分期螺旋CT與病理學(xué)的對(duì)照研究 [J]. 腹部影像學(xué), 2006, 21(11): 11551158.
22. Wei WZ, Yu JP, Li J, et al. Evaluation of contrastenhanced helical hydroCT in staging gastric cancer [J]. World J Gastroenterol, 2005, 11(29): 45924595.
23. Bhandari S, Shim CS, Kim JH, et al. Usefulness of threedimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology [J]. Gastrointest Endosc, 2004, 59(6): 619626.
24. Habermann CR, Weiss F, Riecken R, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US [J]. Radiology, 2004, 230(2): 465471.
  1. 1. Sun Z, Xu HM. Stage and microscopic positive margins in the treatment of patients with gastric cancer [J]. Ann Surg Oncol, 2010, 17(3): 943945.
  2. 2. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1 000 cases [J]. Ann Surg, 1994, 220(1): 5052.
  3. 3. Michels MA. Blood supply and anatomy of the upper abdominal organs [J]. Proc R Soc Med, 1956, 49(9): 683.
  4. 4. Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual (7th ed) [M]. New York, NY: Springer, 2010: 113.
  5. 5. D’Elia F, Zingarelli A, Palli D, et al. Hydrodynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases [J]. Eur Radiol, 2000, 10(12): 18771885.
  6. 6. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation [J]. Am J Surg, 1966, 112(3): 337347.
  7. 7. Chen CY, Lee RC, Tseng HS, et al. Normal and variant anatomy of hepatic arteries: angiographic experience [J]. Zhonghua Yi Xue Za Zhi (Taipei), 1998, 61(1): 1723.
  8. 8. Winter TC 3rd, Freeny PC, Nghiem HV, et al. Hepatic arterial anatomy in transplantation candidates: evaluation with threedimensional CT arteriography [J]. Radiology, 1995, 95(2): 363370.
  9. 9. Weszelits V, Doros A, Puhl M, et al. 3D CT angiography in patients before and after liver transplantation [J]. Transplant Proc, 2001, 33(12): 13721376.
  10. 10. Stemmler BJ, Paulson EK, Thornton FJ, et al. Dualphase 3D MDCT angiography for evaluation of the liver before hepatic resection [J]. AJR Am J Roentgenol, 2004, 183(6): 15511557.
  11. 11. 葉啟發(fā). 肝動(dòng)脈變異與肝移植的關(guān)系 [J]. 中國(guó)現(xiàn)代手術(shù)學(xué)雜志, 2006, 10(6): 401403.
  12. 12. Laghi A, Catalano C, Iannaccone R, et al. Multislice spiral CT angiography in the evaluation of the anatomy of splanchnic vessels: preliminary experience [J]. Radiol Med, 2001, 102(3): 127131.
  13. 13. Chang L, Babineau TJ. Simulation training for surgical residents: cool computers or core curriculum? [J]. Curr Surg, 2006, 63(1): 48.
  14. 14. Napieralski R, Ott K, Kremer M, et al. Methylation of tumorrelated genes in neoadjuvanttreated gastric cancer: relation to therapy response and clinicopathologic and molecular features [J]. Clin Cancer Res, 2007, 13(17): 50955102.
  15. 15. Roth AD, Fazio N, Stupp R, et al. Docetaxel, cisplatin, and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase Ⅱ trial of the Swiss Group for Clinical Cancer Research [J]. J Clin Oncol, 2007, 5(22): 32173223.
  16. 16. Lee IJ, Lee JM, Kim SH, et al. Helical CT evaluation of the preoperative staging of gastric cancer in the remnant stomach [J]. AJR Am J Roentgenol, 2009, 192(4): 902908.
  17. 17. Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging [J]. Abdom Imaging, 2005, 30(4): 465472.
  18. 18. Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review [J]. J Clin Oncol, 2007, 25(15): 21072116.
  19. 19. 黃子星, 陳心足, 宋彬, 等. 64排螺旋CT對(duì)Ⅳ期胃癌術(shù)前分期的價(jià)值 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(8): 623627.
  20. 20. 曲寧, 羅婭紅. 多層螺旋CT在胃癌TNM分期中的診斷價(jià)值 [J]. 實(shí)用腫瘤學(xué)雜志, 2007, 21(6): 551554.
  21. 21. 高劍波, 郭華, 楊學(xué)華, 等. 胃癌TNM分期螺旋CT與病理學(xué)的對(duì)照研究 [J]. 腹部影像學(xué), 2006, 21(11): 11551158.
  22. 22. Wei WZ, Yu JP, Li J, et al. Evaluation of contrastenhanced helical hydroCT in staging gastric cancer [J]. World J Gastroenterol, 2005, 11(29): 45924595.
  23. 23. Bhandari S, Shim CS, Kim JH, et al. Usefulness of threedimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology [J]. Gastrointest Endosc, 2004, 59(6): 619626.
  24. 24. Habermann CR, Weiss F, Riecken R, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US [J]. Radiology, 2004, 230(2): 465471.