Angioarchitectonics of Jejunum on the Experience of 30 Jejunal Interposition After Gastrectomy and Possibilities of MSCT-Diagnostics in Preoperative Planning of a Volume Implant

Thanks to a method of a transillumination it is possible to estimate accurately safety of a blood-groove in a transplant at reconstruction of a digestive tract after a gastrectomy. The venous thrombosis is a specific complication of jejunal interposition. Knowledge of them allowes to minimize risk of intra- and postoperative complications. During a surgery a transillumination can clearly assess the bloodstream in order to detect venous thrombosis and to assess the viability of the transplant at whole. Objective: to evaluate the possibility of MDCT diagnosis in order to plan of jejunal transplant formation before surgery based on a created of new classification of jejunal angioarchitectonics. Material and methods. Research conducted in two stages. First stage. Research included 30 patients with a cancer of a stomach who were on treatment from June, 2012 to December, 2013 in A.V. Vishnevsky Institute of Surgery. MDCT with contrast enhancement carried out to all patients to operation for the purpose of an assessment prevalence of oncological process and an assessment of blood supply and anatomic features of the vascular cource and possibility of vessels of a jejunum. Gastrectomy with one-stage jejunal interposition executed to all patients with the estimation of angioarchitectonics jejunum. Intraoperative data on angioarchitectonics jejunum, received by means of transillumination, compared to results of the MSCT-angiography. Second stage. As groups of comparison and for confirmation of frequency of occurrence of various options of angioarchitectonics jejunum carried out the analysis of section data in casual selection of 30 corpses of adults and results of 30 casual angiography of abdominal aorta. Results. The defined types and variants of angioarchitectonics arteries jejunum were following: stem type - 23.3%, arcuate type - 41.1%, branchy type - 18.9%, scattered type - 16.7%. The sensitivity of MdCt in evaluation of angioarchitectonics jejunum is 93.3%, specificity - 100%, general accuracy - 93.8%. An arcuate type of angioarchitectonics was detected in 2 patients by MDCT-angiography, while intraoperatively they were interpreted as scattered. Conclusion. First we determined two anatomic types and four variants of jejunal angioarchitectonics as the significant criterion for the formation of segmental transplant. A preoperative MDCT with bolus contrast enhancement preliminary makes it possible to model a jejunal transplant.

ангиоархитектоника тощей кишки, МСКТ, еюногастропластика, jejunal angioarchitectonics, MDCT, jejunal interposition

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