Abstract: Objective:To investigate the local anatomical characteristics of the associated membrane and mesangial space in the complete mesocolic excision (CME) of right hemicolectomy and provide the surgical practical anatomical evidence to CME.
Methods:The experimental study was conducted. Department of Anatomy of Capital Medical University provided 20 adult cadavers. The surgical pictures came from Beijing Friendship Hospital of Capital Medical University. The local anatomy of CME in 20 cadavers was simulated after fascia perfusion. Observation indicators: (1) the local anatomy of the visceral fascia and parietal fascia was studied by simulating the operation of CME in cadaver specimens; (2) observing the integrity and barrier action of the visceral layer of the membrane after fascia perfusion solution freezing; (3) distribution and variation of superior vessels of right-semi mesocolon.
Results: (1) The local anatomy of the visceral fascia and parietal fascia was studied by simulating the operation of CME in cadaver specimens: posterior lobe of the interposition mesocolon merged completely with visceral fascia, parietal fascia and front fascia of duodenum, and superior mesenteric vein (SMV) and superior mesenteric artery (SMA) were found. The ureters and reproductive vessels were covered with Gerota fascia, with a complete membrane structure. The specimens from simulated CME in 20 adult cadavers and CME of right hemicolectomy accorded with a requirement of CME. (2) Observing the integrity and barrier action of the visceral layer of the membrane after fascia perfusion solution freezing: posterior lobe of the right-semi mesocolon merged completely with visceral fascia, with a complete parietal fascia structure and without exudation of fascia perfusion solution. The right ureter and reproductive vessels were completely covered with Gerota fascia. The serosal surface of right-semi mesocolon maintained integrity, with exudation of fascia perfusion solution. (3) Distribution and variation of superior vessels of right-semi mesocolon: major blood vessels of right-semi colon included superior mesenteric vessels, including SMA and SMV. The major branches of vessels included ileocolic artery, right colic artery, middle colic artery, right and left branches of middle colic artery, ileocolic vein, middle colic vein and gastrocolic stem. The gastrocolic stem and main stem of right colic artery had more variations.
Conclusion:The posterior lobe of the interposition mesocolon merges with fascia, and complete visceral fascia, can be separated, these provide anatomical evidences for safety and radical resection of right hemicolectomy based on following the principles of CME.