盲升结肠癌患者肠系膜上静脉与胃结肠静脉干直径的变化  

Changes in diameter of superior mesenteric vein and gastrocolic trunk in patients with cecumascending colon cancer

作　　者：邱英良 贾应梅 蔡华崧[1] 李子平[1] 宋晨宇[1] 冯仕庭[1] Qiu Yingliang;Jia Yingmei;Cai Huasong;Li Ziping;Song Chenyu;Feng Shiting(Deportment of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China)

机构地区：[1]中山大学附属第一医院医学影像科,广州510080

出　　处：《中华胃肠外科杂志》2018年第6期691-695,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金项目（81571750）;广东省自然科学基金（2015A030313043、2014A030311018）;广东省科技计划项目（2014A020212125）

摘　　要：目的比较盲升结肠癌患者与正常人群肠系膜上静脉（SMV）和胃结肠静脉干（GCT）直径的差异，并评估SMV和GCT直径对盲升结肠癌的诊断价值。 方法回顾性分析2014年6月至2016年12月间在中山大学附属第一医院经术后病理证实的60例原发性盲升结肠癌患者的术前CT影像资料，在CT图像中测量SMV与GCT的直径。SMV的测量位置是SMV与脾静脉交汇点下方约2 cm处；GCT的测量位置是右结肠静脉、胃网膜右静脉和胰十二指肠前静脉汇合部近端1 cm处。另收集60例接受腹盆腔CT检查但未见明确的器质性病变的患者作为对照组。比较结肠癌组与对照组患者SMV与GCT直径的差异。并采用受试者工作特征（ROC）曲线分析SMV和GCT直径对盲升结肠癌的诊断价值。 结果60例盲升结肠癌患者中男性36例，女性24例，年龄28~84（中位数48）岁。盲肠癌13例，升结肠癌47例。无淋巴结及肝转移者11例，淋巴结转移者40例，肝转移者9例（均合并淋巴结转移）。与对照组相比，盲升结肠癌组患者SMV和GCT直径均显著增加[SMV：（11.2 ± 1.3）mm比（9.5 ± 1.7）mm，t= 6.04，P 〈 0.001；GCT：（5.5 ± 0.9）mm比（3.5 ± 1.0）mm，t= 11.51，P 〈 0.001]。而在盲升结肠癌组中，肝转移、淋巴结转移与无转移患者SMV和GCT直径的差异均无统计学意义（均P 〉 0.05）。ROC曲线分析显示，SMV直径诊断盲升结肠癌的曲线下面积为0.777，取最佳截点10.5 mm，其灵敏度和特异度分别为95.0%（57/60）和46.7%（28/60）。GCT直径诊断盲升结肠癌的曲线下面积为0.923，取最佳截点4.5 mm，其灵敏度和特异度分别为88.3%（53/60）和85.0%（51/60）。 结论SMV和GCT的扩张可能成为盲升结肠癌发生的预警因子，尤以GCT直径更为理想。ObjectiveTo compare the difference of the diameters of superior mesenteric vein （SMV） and gastrocolic trunk （GCT） between patients with cecum-ascending colon cancer and normal individuals, and to assess the diagnostic value of the diameters of SMV and GCT in cecum-ascending colon cancer. MethodsPreoperative imaging data of 60 patients with primary cecum-ascending colon cancer confirmed by postoperative pathology at the First Affiliated Hospital of Sun Yat-sen University from June 2014 to December 2016 were retrospectively analyzed. The diameters of SMV and GCT were measured on preoperative CT images. SMV was measured at about 2 cm below the junction of SMV and splenic vein. GCT was measured at 1 cm near the proximal junction of right colon vein, right gastroepiploic vein and anterior pancreaticoduodenal vein. Another 60 people receiving pelvic CT examination without organ illness were collected as control. The diameter differences of SMV and GCT between cancer group and control group were compared. The diagnostic value of the diameters of SMV and GCT in cecum-ascending colon cancer was evaluated by receiver operating characteristic （ROC） curves. ResultsAmong 60 cases of cecum-ascending colon cancer, 36 were males and 24 were females with median age of 48 years （range 28-84） ; 13 were cecum cancer, 47 were ascending colon cancer; 11 had no lymph node and liver metastasis, 40 had lymph node metastasis, 9 had liver metastasis （all with lymph node metastasis） . Compared to control group, the diameters of SMV and GCT in cancer group were significantly longer [SMV： （11.2±1.3） mm vs. （9.5±1.7） mm, t= 6.04, P 〈 0.001; GCT： （5.5±0.9） mm vs. （3.5±1.0） mm, t= 11.51, P 〈 0.001]. However, there were no statistically significant differences in diameters of SMV and GCT among hepatic metastasis, lymph node metastasis and no metastasis cancer groups （all P 〉 0.05） . The ROC curve analysis showed that the area under the curve of SMV diameter was 0.777, and the optimal cut

关 键 词：结肠肿瘤 肠系膜上静脉 胃肠静脉干 CT 诊断价值 

分 类 号：R735.35[医药卫生—肿瘤]