目的:腹腔镜胃癌根治手术中遇到胃周血管解剖变异时，常会影响术者判断而延长手术时间，甚至造成误伤引起手术并发症，而无法保证手术的安全和质量。本研究术前利用3D模拟软件重建多排CT（3D-CT）描述胃周血管腹腔干和脾动脉的变异情况，分析其描述的不同血管变异情况对腹腔镜全胃切除加Dn 2淋巴清扫术（LTG+Dn 2LD）的指导作用。n 方法:采用回顾性队列研究方法。病例纳入标准：（1）胃癌为进展期，术前均行消化内镜、64排增强CT扫描等检查，病理组织学诊断为胃腺癌；（2）重建了3D-CT模拟影像以指导手术；（3）均为同一组手术团队施行LTG+Dn 2LD手术；（4）临床资料齐全，患者均签署知情同意书。河南省人民医院胃肠外科2014年至2018年间98例胃癌患者入组。腹腔干的变异按Adachi的6个分类归纳为常见型（AdachiⅠ型）和罕见型（AdachiⅡ~Ⅵ型）；脾动脉根据Natsume分类被分为“平坦型”和“弯曲型”。根据3D CT模拟影像，描述患者的腹腔干和脾动脉变异情况，比较不同动脉变异类型组间的手术时间、术中出血量以及术后检出淋巴结数的差异。n 结果:本组患者腹腔干常见型84例（86%），罕见型14例，其中Ⅱ型6例（6%），Ⅲ型2例（2%），Ⅳ型2例（2%），Ⅴ型3例（3%），Ⅵ型1例（1%）；未发现其他类型。腹腔干常见型与罕见型两组患者的临床特征及术中淋巴结检出数方面比较，差异均无统计学意义（均n P>0.05）。与腹腔干常见型患者比较，罕见型患者的LTG+Dn 2LD手术时间长[（321.1±29.0）min比（295.1±46.5）min，n t=2.081，n P=0.040]，术中出血量多（中位数：66.0 ml比32.0 ml，n Z=-4.974，n P=0.001），差异均有统计学意义。脾动脉平坦型患者41例（42%），弯曲型患者57例（58%），两组患者在一般临床特征及术中出血量、手术时间以及淋巴结检出数方面比较，差异均无统计学意义（均n P>0.05）。n 结论:3D CT模拟影像描述胃周血管变异的方法对腹腔镜胃癌根治手术具有一定的临床价值。腹腔干变异时，LTG+Dn 2LD手术时间会延长并可能增加出血量；而脾动脉是否变异对LTG+Dn 2LD手术无影响。n “,”Objective:Anatomic variations in the perigastric vessels during laparoscopic radical gastrectomy often affect the operator's judgment and prolong the operation time, and even cause accidental injury and surgical complications, and hence the safety and quality of the operation cannot be ensured. In this study, multiple slice CT was reconstructed by 3-dimensional CT simulation software (3D-CT), and 3D-CT images were used to describe the variation of celiac trunk and splenic artery before surgery. The guiding role of the different variation of vessels was analyzed for laparoscopic total gastrectomy+D2 lymph node dissection (LTG+D2LD).Methods:A retrospective cohort study was conducted. Case inclusion criteria: (1) Gastric cancer was at an advanced stage. All the patients were preoperatively examined by digestive endoscopy and 64-row enhanced CT scan, and were histopathologically diagnosed with gastric adenocarcinoma. (2) 3D-CT simulation images were reconstructed to guide the operation. (3) LTG+D2LD surgery was performed by the same surgical team. (4) Clinical data were complete, and all the patients had signed the informed consent. From 2014 to 2018, 98 patients with gastric cancer at the Gastrointestinal Surgery Department of Henan Provincial People's Hospital were enrolled. According to the Adachi classification, celiac trunk variation was divided into common type (Adachi type I) and rare type (Adachi type II-VI). According to the Natsume classification, splenic artery was classified into “flat type” and “curved type”. Based on 3D-CT simulation images, variation of celiac trunk and splenic artery was described, and the differences in operation time, intraoperative blood loss and the number of postoperative retrieved lymph nodes were compared between groups with different types of arterial variation.Results:For celiac trunk, common type was found in 84 cases (86%) and rare type was found in 14 cases, including 6 cases (6%) of type II, 2 cases (2%) of type III, 2 cases (2%) of type IV, 3 cases (3%) of type V, 1 case (1%) of type VI. No other types were found. There were no statistically significant differences in clinical characteristics and number of retrieved lymph nodes between patients of the common type group and rare type group (all n P>0.05). Compared with common type patients, those of rare type had longer operative time [(321.1±29.0) minutes vs. (295.1±46.5) minutes,n t=2.081, n P=0.040] and more intraoperative blood loss (median: 66.0 ml vs. 32.0 ml, n Z=-4.974, n P=0.001). For splenic artery, 41 patients (42%) were flat type and 57 patients (58%) were curved type. There were no statistically significant differences between the two groups in terms of clinical characteristics, intraoperative blood loss, operative time and number of retrieved lymph nodes (all n P>0.05).n Conclusions:The method of describing the variation in the perigastric vessels by 3D-CT simulation has certain clinical value in laparoscopic radical gastrectomy. The duration of LTG+D2LD is prolonged and the intraoperative blood loss is increased with the variation of celiac trunk, while the variation of splenic artery has no effect on LTG+D2LD.