中低位直肠癌腹腔镜全直肠系膜切除术难易程度的骨盆MRI分析  

Pelvic MRI analysis about the difficulty of laparoscopic total mesorectal resection for middle and low rectal cancer

作　　者：吴晗 周英军 张婷 高成生 杨辉 WU Han;ZHOU Yingjun;ZHANG Ting(Operating Room,the First Affiliated Hospital of Shandong First Medical University,Qianfoshan Hospital,Jinan 250014,China)

机构地区：[1]山东第一医科大学第一附属医院山东省千佛山医院手术室,山东济南250014 [2]济南市莱芜人民医院普通外科 [3]山东第一医科大学第一附属医院山东省千佛山医院结直肠外科

出　　处：《腹腔镜外科杂志》2023年第7期519-523,共5页Journal of Laparoscopic Surgery

摘　　要：目的:通过测量中低位直肠癌患者骨盆MRI扫描图像数据,分析影响腹腔镜全直肠系膜切除术难易程度的相关指标。方法:回顾性收集2020年3月至2022年4月确诊为直肠癌且行腹腔镜全直肠系膜切除术的180例患者的临床资料,患者均于术前1周内行盆腔MRI检查。分析患者的MRI测量指标、人口及临床指标、手术难度指标。MRI测量指标包括入口前后径、入口横径、出口前后径、出口横径、中骨盆平面横径、骶骨长度、骶骨深度;人口及临床指标包括年龄、性别、BMI、肿瘤最大径、肿瘤MRI分期、病理分期、环周切缘阳性情况及肿瘤下缘距肛缘距离;手术难度指标为手术时间、术中出血量。单因素分析采用Spearman秩相关性分析,并进行多因素Logistic回归分析,确定MRI测量指标、人口及临床指标与手术难度的相关性。结果:单因素相关分析结果显示,年龄与术中出血量相关(P<0.05),入口横径、肿瘤下缘距肛缘距离、骶骨深度与手术时间相关(P<0.05)。多因素相关分析结果显示,入口横径、肿瘤下缘距肛缘距离是影响手术时间的主要因素(P<0.05)。结论:中低位直肠癌患者的骨盆MRI参数中,入口横径越小、肿瘤下缘距肛缘距离越近行腹腔镜全直肠系膜切除术的难度越大,术前骨盆MRI可为中低位直肠癌腹腔镜全直肠系膜切除手术难度的评估提供帮助。Objective:To analyze the relevant indicators that affect the difficulty of laparoscopic total mesorectal resection by measuring the pelvic MRI scan image data of patients with middle and low rectal cancer.Methods:Clinical data of 180 patients diagnosed with rectal cancer who underwent laparoscopic total mesorectal resection surgery from Mar.2020 to Apr.2022 were retrospectively collected.All patients underwent pelvic MRI within 1 week before surgery.The MRI measurement indexes,demographic and clinical i ndexes,and surgical difficulty indexes of the patients were analyzed.MRI measurements indicators included anteroposterior diameter of entrance,transverse diameter of entrance,anteroposterior diameter of exit,transverse diameter of exit,transverse diameter of middle pelvis,length of sacrum,depth of sacrum;population and clinical indicators included age,gender,BMI,the largest diameter of the tumor,MRI staging,pathological staging,positive circumferential margin of tumor and distance from inferior tumor edge to anal verge;surgical difficulty indicators were operation time and intraoperative blood loss.Univariate analysis was performed using Spearman rank correlation analysis and multivariate logistic regression analysis was performed to determine the correlation between MRI measurement indicators,population and clinical indicators,and surgical difficulty.Results:Univariate correlation analysis showed that age was related to intra-operative blood loss(P<0.05),and transverse inlet diameter,the distance from the lower edge of the tumor to the anal verge,and the depth of the sacrum were related to the operation time(P<0.05).The results of multivariate correlation analysis showed that the transverse diameter of the entrance and the distance from the lower edge of the tumor to the anal verge were the main factors affecting the o peration time(P<0.05).Conclusions:Among the pelvic MRI parameters of patients with middle and low rectal cancer,the smaller the transverse diameter of the entrance and the closer the distance betwe

关 键 词：直肠肿瘤 全直肠系膜切除术 腹腔镜检查 磁共振成像 手术难度 

分 类 号：R735.37[医药卫生—肿瘤]