Anatomic analysis of the right colonic vessels in the laparoscopic right hemicolectomy / 中华消化外科杂志

ABSTRACT

Objective To analyze the anatomy of the right colonic vessels in the laparoscopic right hemicolectomy.Methods The retrospective cross-sectional study was conducted.The clinical data of 60 patients who underwent laparoscopic right hemicolectomies in the Second Affiliated Hospital of Fujian Medical University from March 2013 to October 2016 were collected.All the patients used central approach.Patients intraoperatively underwent complete mesocolic excision (CME),and vascular anatomies of the right colon were precisely distinguished through postoperatively observing video.The starting position,formation and relative spatial location of vessels were counted and analyzed,and video screenshots were used as a comments during analysis.Observation indicators(1) superior mesenteric artery (SMA) and superior mesenteric vein (SMV)occurrence rate and relative spatial location;(2) ileocolic artery and veinoccurrence rate and relative spatial location;(3) right colonic artery and veinoccurrence rate and relative spatial location of right colonic artery,occurrence rate and distribution of right colonic vein flowed into superior vein;(4) gastrocolic venous trunkoccurrence rate and composition of the branches;(5) middle colonic artery and veinoccurrence rate and relative spatial location of middle colonic artery,occurrence rate and distritution of middle colonic vein flowed into superior vein.Measurement data were represented as proportion and percentage.Results (1) SMA and SMVall the 60 patients appeared SMA and SMV,with an occurrence rate of 100.0％(60/60).Of 60 patients,95.0％(57/60) and 5.0％(3/60) patients' SMAs respectively were located on the left side and right side of SMVs.(2) Ileocolic artery and veinof 60 patients,the occurrence rates of ileocolic artery and vein were 96.7％ (58/60) and 100.0％ (60/60).Relative spatial locationof 58 patients with ileocolic artery,8.6％ (5/58),31.0％ (18/58),10.3％ (6/58),6.9％(4/58),32.9％(19/58) and 10.3％(6/58) patients' ileocolic arteries were respectively located on the right ahead,anterosuperior,inferoanterior,right behind,upper posterior and lower posterior of ileocolic veins;50.0％(29/58) patients' ileocolic arteries crossed from the front of SMV,and 50.0％ (29/58) patients' ileocolic arteries ran behind the SMV.(3) Right colonic artery and vein① Right colonic arteryof 60 patients,occurrence rate was 55.0％(33/60),including 93.9％(31/33) with 1 right colonic artery and 6.1％(2/33) with 2 right colonic arteries.A trunk made of right colonic artery and middle colonic artery was detected in 24.2％ (8/33) patients,and flowed into SMA,including 2/8 patients with 2 right colonic arteries and 6/8 with 1 right colonic artery.Relative spatial locationof 33 patients,90.9％ (30/33) occurred right colonic artery crossed from the front of SMV;9.1％ (3/33) occurred SMA located on the right side of SMV that led to no relative spatial location between right colonic artery and SMV.② Right colonic veinof 60 patients,occurrence rate was 93.3％ (56/60),including 87.5％(49/56) with 1 right colonic vein (7 were accompanied by right colonic artery) and 12.5％ (7/56) with 2 right colonic veins.Distribution of right colonic vein flowed into superior veinof 49 patients with 1 right colonic vein,right colonic vein respectively flowed into gastrocolic venous trunk and SMV were detected in 73.5％ (36/49) and 26.5％ (13/49) patients.Of 7 patients with 2 right colonic veins,right colonic vein flowed into SMV and gastrocolic venous trunk were detected respectively in 6/7 patients and 1/7 patients.(4) Gastrocolic venous trunkoccurrence rate was 88.3％ (53/60);11.7％ (7/60) patients had absence of gastrocolic venous trunk,and right gastric epiploic vein directly flowed into SMV.Composition of the branches of gastrocolic venous trunkof 53 patients,3-branch or 4-branch stomach-pancreas-colon venous trunk in 54.7％ (29/53) patients was made up of right gastric epiploic vein,pancreaticoduodenal vein,right colonic vein and middle colonic vein;2-branch or 3-branch gastrocolic venous trunk in 35.9％ (19/53) patients was made up of right gastric epiploic vein,right colonic vein and middle colonic vein;2-branch stomach-pancreas venous trunk in 9.4％ (5/53) patients was made up of right gastric epiploic vein and pancreaticoduodenal vein.(5) Middle colonic artery and vein① Middle colonic artery60 patients appeared middle colonic artery,with an occurrence rate of 100.0％ (60/60) and 1.7％ (1/60) appeared 2 middle colonic arteries.Of 60 patients,13.3％ (8/60) patients' middle colonic artery shared the same trunk together with right colonic artery that flowed into 1 middle colonic artery,and 85.0％(51/60) appeared 1 middle colonic artery.Middle colonic artery ≤ 1 cm,from 1 to 2 cm (excluding 1 cm) and ＞2 cm occurred branch at running out of neck of pancreas were detected in 15.7％ (8/51),66.7％ (34/51) and 66.7％ (34/51)patients,respectively.② Middle colonic vein56 of 60 patients appeared middle colonic vein,with an occurrence rate of 93.3％(56/60),and 80.3％(45/56),16.1％(9/56) and 3.6％(2/56) patients appeared respectively 1,2 and 3 middle colonic veins.Distribution of middle colonic vein flowed into superior vein45 patients appeared 1 middle colonic vein,55.6％ (25/45) and 44.4％ (20/45) middle colonic veins respectively flowed into SMV and gastrocolic venous trunk;9 patients appeared 2 middle colonic veins,7/9 middle colonic veins flowed into SMV and gastrocolic venous trunk and 2/9 middle colonic veins flowed into SMV;2 patients appeared 3 middle colonic veins,1 and 2 middle colonic veins respectively flowed into gastrocolic venous trunk and SMV.Conclusion Vascular anatomical variations of the right colon are complex in the laparoscopic right hemicolectomy,and anatomies of the surgical thunk and Helen trunk are difficult and core issue in operation.