Abstract：
OBJECTIVE: To describe residual arterial supply to the stomach after bariatric surgery via a systematic arterial-phase CT assessment approach that can aid in diagnosis and treatment of postoperative complications and facilitate planning for future procedures.
METHODS: Arterial-phase CT of 46 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at 3 academic institutions were retrospectively reviewed to assess patency of left gastric artery (LGA), right gastric artery (RGA), gastroepiploic artery (GEA), and left inferior phrenic artery (LIPA) and presence of gastric perforators.
RESULTS: In 25 RYGB and 21 SG patients, mean diameters were LGA 2.2 ± 0.4 mm, RGA 1.6 ± 0.5 mm, and GEA 1.7 ± 0.4 mm. On RYGB scans, all LGAs, RGAs, and 24/25 (96%) of GEAs were identified. Excellent to good patency was seen in 20/25 (80%) LGAs, 21/25 (84%) RGAs, and 23/24 (96%) GEAs. On SG scans, all LGAs, 18/21 (86%) of RGAs, and 20/21 (95%) GEAs were identified. Excellent to good patency was seen in 17/21 (81%) LGAs, 15/18 (83%) RGAs, and 20/20 (100%) GEAs. In terms of gastric perforators, LGA supply was seen on 23/25 (92%) of RYGB and 17/17 (100%) of SG scans. RGA supply was seen on 13/21 (62%) RYGB and 9/18 (50%) SG scans. GEA supply was seen on 19/23 (83%) RYGB scans. No gastric supply via GEA was seen on SG scans.
CONCLUSIONS: In this study, arterial supply to the stomach through the LGA was consistently identified in all RYGB and SG cases, indicating an uncomplicated surgical approach with regard to preserving the LGA. Dedicated CT angiography protocol or catheter-directed angiography is recommended for accurate and comprehensive assessment of the gastric blood supply, particularly before surgical re-intervention.
METHODS: Arterial-phase CT of 46 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at 3 academic institutions were retrospectively reviewed to assess patency of left gastric artery (LGA), right gastric artery (RGA), gastroepiploic artery (GEA), and left inferior phrenic artery (LIPA) and presence of gastric perforators.
RESULTS: In 25 RYGB and 21 SG patients, mean diameters were LGA 2.2 ± 0.4 mm, RGA 1.6 ± 0.5 mm, and GEA 1.7 ± 0.4 mm. On RYGB scans, all LGAs, RGAs, and 24/25 (96%) of GEAs were identified. Excellent to good patency was seen in 20/25 (80%) LGAs, 21/25 (84%) RGAs, and 23/24 (96%) GEAs. On SG scans, all LGAs, 18/21 (86%) of RGAs, and 20/21 (95%) GEAs were identified. Excellent to good patency was seen in 17/21 (81%) LGAs, 15/18 (83%) RGAs, and 20/20 (100%) GEAs. In terms of gastric perforators, LGA supply was seen on 23/25 (92%) of RYGB and 17/17 (100%) of SG scans. RGA supply was seen on 13/21 (62%) RYGB and 9/18 (50%) SG scans. GEA supply was seen on 19/23 (83%) RYGB scans. No gastric supply via GEA was seen on SG scans.
CONCLUSIONS: In this study, arterial supply to the stomach through the LGA was consistently identified in all RYGB and SG cases, indicating an uncomplicated surgical approach with regard to preserving the LGA. Dedicated CT angiography protocol or catheter-directed angiography is recommended for accurate and comprehensive assessment of the gastric blood supply, particularly before surgical re-intervention.
摘要：
目的：通过系统的动脉期CT评估方法描述减肥手术后胃的残余动脉供应，该方法可以帮助诊断和治疗术后并发症，并有助于规划未来的手术。
方法：回顾性分析了在3个学术机构接受Roux-en-Y胃旁路术（RYGB）或袖状胃切除术（SG）的46例患者的动脉期CT，以评估左胃动脉（LGA）的通畅性。右胃动脉(RGA),胃表皮动脉（GEA），和左膈下动脉（LIPA）和胃穿孔的存在。
结果：在25例RYGB和21例SG患者中，平均直径为LGA2.2±0.4毫米，RGA1.6±0.5mm,和GEA1.7±0.4mm。在RYGB扫描中,所有LGA,RGA,并确定了24/25（96％）的GEA。在20/25（80％）的LGA中发现了良好的通畅性，21/25（84%）RGA，和23/24（96%）GEAs。在SG扫描中，所有LGA,18/21（86%）的RGA，和20/21(95%)GEA被确定。在17/21(81%)的LGA中观察到良好的通畅性，15/18（83%）RGA，和20/20（100%）GEAs。就胃穿孔器而言,在RYGB的23/25(92%)和SG扫描的17/17(100%)上观察到LGA供应。在13/21(62%)RYGB和9/18(50%)SG扫描上看到RGA供应。在19/23(83%)RYGB扫描中发现了GEA供应。SG扫描中未发现通过GEA进行的胃供应。
结论：在这项研究中，在所有RYGB和SG病例中，通过LGA向胃的动脉供应得到一致确认，表明在保留LGA方面手术方法简单。建议使用专用的CT血管造影协议或导管导向血管造影，以准确和全面地评估胃血液供应，特别是在手术再干预之前。
方法：回顾性分析了在3个学术机构接受Roux-en-Y胃旁路术（RYGB）或袖状胃切除术（SG）的46例患者的动脉期CT，以评估左胃动脉（LGA）的通畅性。右胃动脉(RGA),胃表皮动脉（GEA），和左膈下动脉（LIPA）和胃穿孔的存在。
结果：在25例RYGB和21例SG患者中，平均直径为LGA2.2±0.4毫米，RGA1.6±0.5mm,和GEA1.7±0.4mm。在RYGB扫描中,所有LGA,RGA,并确定了24/25（96％）的GEA。在20/25（80％）的LGA中发现了良好的通畅性，21/25（84%）RGA，和23/24（96%）GEAs。在SG扫描中，所有LGA,18/21（86%）的RGA，和20/21(95%)GEA被确定。在17/21(81%)的LGA中观察到良好的通畅性，15/18（83%）RGA，和20/20（100%）GEAs。就胃穿孔器而言,在RYGB的23/25(92%)和SG扫描的17/17(100%)上观察到LGA供应。在13/21(62%)RYGB和9/18(50%)SG扫描上看到RGA供应。在19/23(83%)RYGB扫描中发现了GEA供应。SG扫描中未发现通过GEA进行的胃供应。
结论：在这项研究中，在所有RYGB和SG病例中，通过LGA向胃的动脉供应得到一致确认，表明在保留LGA方面手术方法简单。建议使用专用的CT血管造影协议或导管导向血管造影，以准确和全面地评估胃血液供应，特别是在手术再干预之前。
