多层螺旋CT血管造影术在结肠癌腹腔镜术前评估中的价值  

Multi-slice spiral Computed Tomography angiography in laparoscopic surgery for colorectal carcinoma

作　　者：赵欣[1] 戎祯祥[2] 潘壬清[1] 张浩[1] 谢振文[1] 邓周强[1] 曾红辉[1] 

机构地区：[1]广东佛山顺德区新容奇医院放射科,佛山528303 [2]广东佛山顺德区新容奇医院普外科,佛山528303

出　　处：《中华腔镜外科杂志（电子版）》2012年第6期53-56,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：2011年卫生部医药卫生科技发展研究中心基金项目(项目编号:W2011JZC33)

摘　　要：目的评估多层螺旋CT血管造影术在术前显示肠系膜血管的作用,分析其在腹腔镜结直肠癌手术中的意义。方法收集行外科手术治疗的结直肠肿瘤患者52例,其中腹腔镜手术组13例,开放手术组39例。两组病例术前常规行全腹部平扫、增强扫描,对腹部主要血管进行三维重建。采用容积再现法(VR)、最大密度投影(MIP),对肠系膜上动脉(SMA)、右结肠动脉(RCA)、回结肠动脉(ICA)、中结肠动脉(MCA)、肠系膜上静脉(SMV)、肠系膜下动脉(IMA)、左结肠动脉(LCA)、肠系膜下静脉(IMV)等肠系膜主要血管进行术前显示与观察。比较两组间的年龄、性别、Duke's分期、术后肠梗阻发生率、吻合口感染、吻合口漏的发生率。结果右半结肠手术前,观察SMA、MCA、RCA的起始变异与吻合支情况,左半结肠和直肠癌根治术前,观察了IMA根部及LCA、乙状结肠动脉(SCA)起源变异走行情况及IMA与IMV的解剖关系。腹腔镜手术组切口长度(3.98±0.73)cm较开放手术组(16.39±1.92)cm明显缩短,P<0.001。两组间术后肠梗阻、吻合口感染、吻合口漏的发生率差异无统计学意义。结论多层螺旋CT血管造影术及三维重建对腹部血管的术前评估观察,有利于腹腔镜结直肠癌手术中对血管的准确处理。Objective To explore the application value of multi-slice spiral CT angiography （MSCTA） for the preoperative evaluation of laparoscopic surgery for colorectal carcinoma. Methods Fifty-two patients with colorectal cancer who underwent curative operation at our hospital were enrolled in this study. They were classified into two groups by operative procedures. Thirteen patients underwent laparoscopic surgery, laparoscopic group （LG）, while thirty-nine patients underwent conventional open surgery, open group （OG）. All patients underwent abdominal contrast-enhanced CT routinely ,and the 3D images of the major regional vessels are described, including Volume Rendering （VR） and Maximum Intensity Projection （MIP）. We have previously described about the preoperative visualization of the superior mesenteric artery （SMA ）, middle colic artery （MCA）,right colic artery （RCA） , ileocecal artery （ICA）, the inferior mesenteric artery （IMA） ,left colic artery（LCA ） and inferior mesenteric vein （IMV） by 3DCT. We have compared our two study groups with clinical items, including clinical anastomoticleakage, and discussed the role of 3DCT in laparoscopic surgery for colorectal carcinoma.Results In the right-sided colectomy, the anatomical variations between MCA and RCA and SMA were described. In the left-sided colectomy, the anatomical variations and association between IMA and LCA and IMV were described. The mean length of the incision in LG was 3.98±0.73 cm, which was signifi cantly shorter than that in OG （P ＆lt;0.001）. There was no signifi cant difference in postoperative ileus, wound infection and anastomotic leakage, between the two groups. Conclusions Preoperative visualization of the major abdominal vessels by MSCTA is helpful for the secure treatment of the vessels in laparoscopic surgery for colorectal carcinoma.

关 键 词：多层螺旋CT 三维重建技术 腹腔镜外科手术 结直肠肿瘤 

分 类 号：R735.3[医药卫生—肿瘤]