Vascular Anatomy Based On Computed Tomography Three-dimensional Reconstruction And Surgery During Right Hemicolectomy For Right Colon Cancer

Objective:To investigate the variation types,anatomical rules and clinical significance of mesenteric vessels during laparoscopic right hemicolectomy for right colon cancers.under CT three-dimensional reconstruction navigation.To investigate the feasibility of determining the anatomy of vascular anatomy by CT three-dimensional(3D)reconstruction.To explore the surgical treatment of different types of anatomical variation.Methods:From December 2018 to December 2022,A total of 196 patients were selected from the Department of Colorectal Tumor Surgery,Shengjing Hospital,China Medical University.For surgical observation group,the vascular anatomy was marked by reviewing the operation records and complete surgical videos.For 3D reconstruction observation group,The vascular anatomy was marked by reviewing the thin-layer contrast-enhanced CT 3D reconstruction imaging data.The observers of the two groups were blind to each other,and the results were observed and recorded independently.The observation indicators included:superior mesenteric artery(SMA),superior mesenteric vein(SMV),ileocolic artery(ICA),ileocolic vein(ICV),right coloic artery(RCA),right coloic vein(RCV),middle coloic artery(MCA),middle coloic vein(MCV),and Henle trunk.Results:(1)SMA and SMV:182 cases(92.9%)of traditional single SMV.The spatial relationship between single SMV and SMA can be divided into right position,left position and cross position,accounting for 87.8%,0.5%,and 4.6%respectively.There were 4 cases of anterior cross structure and 5 cases of posterior cross structure.14 cases of double SMV.In double SMV group,the left SMV and the right SMV wrapped around the SMA in a"sandwich"like spatial structure.The ICV,RCV,and Henle trunk drained into the right SMV,whereas the jejunal vein(JV)and ileal vein(IV)mainly drained into the left SMV in all patients with double SMV.The double SMV was classified into types I and II based on whether the right and left SMVs formed a common trunk.(2)ICA and ICV:The occurrence rate of ICA and ICV are 100.0%.The ICA runs in the ventral and dorsal sides of SMV in 46.4%and 53.6%,respectively.1 case of ICV directly flowed into Henle trunk.The spatial positions between ICA and ICV are divided into positive anterior position(10.8%),anterior upper position(22.6%),anterior lower position(13.3%),positive posterior position(12.3%),posterior upper position(29.7%),and posterior lower position(11.3%).(3)RCA and RCV:75 cases(38.3%)were RCA.The RCA runs in the ventral and dorsal sides of SMV in 32.1%and 6.1%,respectively.There were 190 cases(96.9%)of RCV,among which single branch,double branch and triple branch RCVs accounted for 46.9%,41.8%and 8.2%respectively.(4)MCA and MCV:The MCAs were found in 190 cases(96.9%)and 192 cases(97.9%)respectively.186 cases(94.9%)had both MCA and MCV.There were 5 kinds of drainage locations including SMV,Henle trunk,inferior mesenteric vein(IMV),splenic vein(SV)and JV.The most common drainage location is SMV.When MCV was multi-branched,the proportion of multi-branched RCV was higher than that of single-branch MCV group(χ~2=24.77,p<0.01),the number variation of MCV was correlated with the number variation of RCV(φ=0.365,p<0.01;r=0.343,p<0.01).(5)Henle trunk:According to whether the superior anterior pancreaticoduodenal vein(ASPDV)and the right gastroepiploic vein(RGEV)share the same trunk and the number of colonic venous branches,Henle trunk can be divided into basic type(0-III type)and special type(I-II type).There are 191 cases(97.4%)of Henle trunk.The basic type 0 to III accounted for 4.1%,41.8%,35.7%,and 8.2%respectively and the special type I and special type II accounted for 4.1%and 3.6%respectively.(6)The consistency check between CT 3D reconstruction group and surgical observation group was carried out.The observational results ranged from high consistency to complete consistency.The coefficient of consistency in identifying the quantity variation of RCV,the occurrence of MCA and MCV,the quantity variation of MCV,the quantity variation of the branches of Henle trunk and variations of the subtypes of Henle trunk accounted for 0.921、0.740、0.657、0.789、0.890 and 0.897,respectively.Conclusion:There were spatial and quantitative anatomical variations in SMA and SMV.The incidence of ileocolic vessels was the most constant.ICA was most commonly located in the posterior superior of ICV.The quantitative variations of RCV were associated with the quantitative variations of MCV.The most common type of Henle trunk was basic type I.The observation results of CT 3D reconstruction are in good consistancy with those of surgery.Doctors can accurately identify the vascular anatomy of the right colon by CT 3D reconstruction before surgery.We should master the different surgical treatments of different types of anatomic variations.