Vascular anatomy of the stomach and its application in gastric tube reconstruction during esophagectomy
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摘要:
目的 本研究旨在了解胃血管, 尤其是胃网膜右动脉的解剖情况, 为食管癌术中管状胃的重建提供参考。 方法 解剖由上海医学院提供的尸体28具, 其中男性18具、女性10具。分别观察并测量各条胃供血动脉的直径及长度, 胃网膜右动脉的长度及其与胃大弯长度的比值, 观察胃网膜左、右动脉的吻合情况。 结果 最终可测得胃左动脉为25条, 直径为3.40(2.10~6.40) mm; 胃右动脉21条, 直径为1.97(0.68~3.56) mm; 胃网膜左动脉26条, 直径为1.87(0.80~2.96) mm; 胃网膜右动脉28条, 直径为2.82 (1.58~4.80) mm, 长度为216.71(120~318) mm; 胃大弯长度为356.39(248~487) mm。胃网膜右动脉长度与胃大弯长度的平均比值为0.61(0.45~0.82)。28具尸体中, 17具发现胃网膜左、右动脉的终支有吻合支, 占60.7%。 结论 通过尸体解剖, 对胃的供应血管进行观察和统计, 计算得到胃各供应血管长度和直径, 推测胃网膜右动脉平均提供胃大弯侧61%的血供, 在60.7%的标本中发现有胃网膜左、右动脉的吻合支。通过基础解剖数据, 以期为食管癌术中管状胃血供的估算及管状胃的最佳重建提供参考。 Abstract:Objective To investigate the vascular anatomy of the stomach, especially the right gastroepiploic artery for the reconstruction of a gastric tube during esophagectomy. Methods The vascular anatomy of the stomach was studiing in 28 embalmed human specimens provided by the Department of Anatomy, Shanghai Medical College, Fudan University, included 10 female and 18 male specimens.The length and diameter of gastric vessels were measured.The ratio of the length of the right gastroepiploic artery to the length of the greater curvature was calculated.Anastomosis between the left and right gastroepiploic arteries was also assessed. Results Twenty-five left gastric arteries were observed in the autopsies, with the mean diameter of 3.40(2.10-6.40) mm.Twenty-one right gastric arteries were measured, with the mean diameter of 1.97(0.68-3.56) mm.Twenty-six left gastroepiploic arteries were observed, with the mean diameter of 1.87(0.80-2.96) mm.Twenty-eight right gastroepiploic arteries were measured, with the mean diameter of 2.82(1.58-4.80) mm.The mean lengths of the 28 right gastroepiploic arteries and their greater curvatures were 216.71(120- 318) mm and 356.39(248-487) mm, respectively.The ratio of the length of right gastroepiploic arteries and greater curvatures was 0.61(0.45-0.82).The anastomosis between the left and right gastroepiploic arteries was observed in 60.7%(17/28) of the specimens. Conclusions The length and diameter of gastric vessels were calculated.It was assumed that the right gastroepiploic artery provides an average of 61% of the blood supply for the great curvature.In addition, the anastomotic branch of the right and left gastroepiploic arteries was observed in 60.7% specimens.These anatomical data allow surgeons to estimate the blood supply and to choose an optimal method of gastric tube reconstruction during esophagectomy. -
Key words:
- esophageal cancer /
- gastric tube /
- gastric vessel /
- right gastroepiploic artery /
- blood supply /
- surgery
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表 1 胃血管解剖学评价
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[1] Chen W, Zheng R, Baade PD, et al.Cancer statistics in China, 2015 [J].CA Cancer J Clin, 2016, 66(2):115-132. doi: 10.3322/caac.21338 [2] Honda M, Kuriyama A, Noma H, et al.Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy:a systematic review and meta-analysis[J].Ann Surg, 2013;257(2):238-248. doi: 10.1097/SLA.0b013e31826d4723 [3] Markar SR, Karthikesalingam A, Vyas S, et al.Hand-sewn versus stapled oesophago-gastric anastomosis:systematic review and metaanalysis[J].J Gastrointest Surg, 2011, 15(5):876-884. doi: 10.1007/s11605-011-1426-9 [4] Zhang W, Yu D, Peng J, et al.Gastric-tube versus whole-stomach esophagectomy for esophageal cancer:A systematic review and meta-analysis[J].PLoS One, 2017, 12(3):e0173416. doi: 10.1371/journal.pone.0173416 [5] 冯明祥, 王群, 谭黎杰, 等.管状胃在微创食管外科中的应用[J].中国胸心血管外科临床杂志, 2010, 17(2):92-95. http://d.old.wanfangdata.com.cn/Periodical/zgxxxgwk98201002002 [6] Hosaka H, Kawamura O, Kusano M, et al.Early esophageal squamous cell carcinoma mimicking reflux esophagitis[J].Gastrointest Endosc, 2010, 71(6):1063. doi: 10.1016/j.gie.2009.12.049 [7] Fujita H, Kakegawa T, Yamana H, et al.Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer.Comparison of three-field lymphadenectomy with two-field lymphadenectomy[J].Ann Surg, 1995, 222(5):654-662. doi: 10.1097/00000658-199511000-00008 [8] Liebermann-Meffert DM, Meier R, Siewert JR.Vascular anatomy of the gastric tube used for esophageal reconstruction[J].Ann Thorac Surg, 1992, 54(6):1110-1115. doi: 10.1016/0003-4975(92)90077-H [9] Buunen M, Rooijens PP, Smaal HJ, et al.Vascular anatomy of the stomach related to gastric tube construction[J].Dis Esophagus, 2008, 21(3):272-274. doi: 10.1111/j.1442-2050.2007.00771.x [10] 张灿斌, 李简, 郑建, 等.胃管成形术在食管重建中的可行性研究[J].河南科技大学学报(医学版), 2005, 23(3):175-179. doi: 10.3969/j.issn.1672-688X.2005.03.006 [11] Zhang FB, Shi HC, Shu YS, et al.Diagnosis and surgical treatment of esophageal gastrointestinal stromal tumors[J].World J Gastroenterol, 2015, 21(18):5630-5634. doi: 10.3748/wjg.v21.i18.5630 [12] Heimlich HJ.Reversed gastric tube (RGT) esophagoplasty for failure of colon, jejunum and prosthetic interpositions[J].Ann Surg, 1975, 182(2):154-160. doi: 10.1097/00000658-197508000-00013 [13] Prudius V, Prochazka V, Pavlovsky Z, et al.Vascular anatomy of the stomach related to resection procedures strategy[J].Surg Radiol Anat, 2017, 39(4):433-440. doi: 10.1007/s00276-016-1746-2 [14] Takeda FR, Cecconello I, Szachnowicz S, et al.Anatomic study of gastric vascularization and its relationship to cervical gastroplasty[J].J Gastrointest Surg, 2005, 9(1):132-137. doi: 10.1016/j.gassur.2004.03.006 [15] Hannoun L, Le Breton C, Bors V, et al.Radiological anatomy of the right gastroepiploic artery[J].Anat Clin, 1984, 5(4):265-271. doi: 10.1007/BF01798750 [16] Collard JM, Tinton N, Malaise J, et al.Esophageal replacement:gastric tube or whole stomach[J]?Ann Thorac Surg, 1995, 60(2):261- 266. doi: 10.1016/0003-4975(95)00411-D [17] el-Eishi HI, Ayoub SF, el-Khalek MA.The arterial supply of the human stomach[J].Acta Anat (Basel), 1973, 86(3):565-580. http://d.old.wanfangdata.com.cn/OAPaper/oai_pubmedcentral.nih.gov_1261631 [18] Koskas F, Gayet B.Anatomical study of retrosternal gastric esophagoplasties[J].Anat Clin, 1985, 7(4):237-256. doi: 10.1007/BF01784641 [19] Randjelovic DT, Filipovic RB, Bilanovic LD, et al.Perigastric vascular abnormalities and the impact on esophagogastrectomy[J].Dis Esophagus, 2007, 20(5):390-398. doi: 10.1111/j.1442-2050.2007.00633.x [20] Matsuki M, Kani H, Tatsugami F, et al.Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy-assisted gastrectomy[J].AJR Am J Roentgenol, 2004, 183(1):145-151. doi: 10.2214/ajr.183.1.1830145 [21] Ishiguro T, Kumagai Y, Ono T, et al.Usefulness of indocyanine green angiography for evaluation of blood supply in a reconstructed gastric tube during esophagectomy[J].Int Surg, 2012, 97(4):340-344. doi: 10.9738/CC159.1 [22] Kumagai Y, Ishiguro T, Haga N, et al.Hemodynamics of the reconstructed gastric tube during esophagectomy:assessment of outcomes with indocyanine green fluorescence[J].World J Surg, 2014, 38(1):138-143. doi: 10.1007/s00268-013-2237-9 -
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