胃癌周围动脉的变异及其在临床手术中的意义

Variations of surrounding arteries of gastric cancer in digital subtraction angiography and its impact on clinical surgery

摘要:

目的： 比较胃癌与非胃癌患者胃周动脉的变异及在临床手术中意义。方法： 回顾性分析2018年1月至2020年1月收治的86例胃癌和92例非胃癌患者的临床资料。所有患者均行数字减影血管造影，影像学资料分析测量胃周围动脉的变异和内径，比较胃癌与非胃癌患者的解剖学差异，并分析血管变异对临床手术难度和术后重大并发症的影响。结果： 在178例患者中，根据胃左动脉（left gastric artery，LGA）进行简单分类，Ⅰ型165例（92.7%），Ⅱ型11例（6.2%），Ⅳ型2例（1.1%）。而根据胃右动脉（right gastric arteries，RGA）进行分类，148例（83.1%）起源于肝固有动脉（proper hepatic artery，PHA），3例（1.7%）起源于胃十二指肠动脉（gastroduodenal artery，GDA），16例（9.0%）起源于肝左动脉或肝右动脉，胃右动脉缺如者11例（6.2%）。LGA、RGA、胃网膜右动脉（right gastroepiploic artery，RGEA）和GDA的平均内径分别为2.50 mm、1.42 mm、1.73 mm和2.89 mm。其中，胃癌患者RGEA平均内径为1.87 mm，明显大于非胃癌患者的1.6 mm（P=0.001）。胃癌患者胃左动脉Ⅰc型手术时间[（254.0±54.0）min]和手术出血量[（113.5±43.0）mL]显著延长，未发现血管变异对手术重点并发症有影响。结论： 胃癌与非胃癌患者胃周动脉在解剖学上无明显差异。相较于非胃癌患者，胃癌患者的RGEA内径更宽。胃左动脉Ⅰc型（腹腔干不仅发出LGA、脾动脉（splenic artery，SA）和肝总动脉（common hepatic artery，CHA）同时还有其他分支发出）患者增加了手术难度。

Abstract:

Objective: To compare the variation in and internal diameters of the surrounding arteries in patients with gastric cancer and non-gastric cancer and analysis it’s impact on surgery. Methods: A retrospective analysis of 86 cases of gastric cancer and 92 cases of non-gastric cancer from January 2018 to January 2020. All patients underwent digital subtraction angiography. The variations and the inner diameters in the gastric surrounding arteries were measured by imaging. The anatomical differences between gastric cancer and non-gastric cancer patients were analyzed. The impacts on surgical difficulty and major surgical complications were also analyzed. Results: There were 165 (92.7%) patients in type I, 11 (6.2%) patients in type II, and 2 (1.1%) patients in type IV according to a simple classification of the left gastric artery. There were 148 (83.1%) right gastric arteries (RGAs) originating from the proper hepatic artery (PHA), 3 (1.7%) originating from the gastroduodenal artery (GDA), and 16 (9.0%) originating from the left hepatic artery or right hepatic artery. The RGA was absent in 11 (6.2%) patients. The average inner diameters of the LGA, RGA, right gastroepiploic artery (RGEA), and GDA were 2.50 mm, 1.42 mm, 1.73 mm, and 2.89 mm, respectively. The average inner diameter of the RGEA was 1.87 mm in gastric cancer patients, which was wider than the 1.60 mm in non-gastric cancer patients (P=0.001). The operation time[ (254.0±54.0) min] and surgical blood loss [ (113.5±43.0) mL] in the patients with the type Ⅰc left gastric artery were significantly prolonged, and we found that the artery variations had no impact on the major complications of the operation. Conclusion: No difference was found in anatomical variation in patients with gastric cancer and non-gastric cancer. Patients with gastric cancer had a wider inner diameter of the RGEA. The type Ⅰc left gastric artery increased the difficulty of surgery.