计算机断层血管造影与结肠成像及融合图像对腹腔镜直肠癌根治术的临床价值  

Clinical value of CTA and CTC and fusion images in laparoscopic radical resection of rectal cancer

作　　者：刘乃绮 谭晓天 闵南[3] 骆承龙 刘仁武 王朝晖[5] Naiqi Liu;Xiaotian Tan;Nan Min;Chenglong Luo;Renwu Liu;Zhaohui Wang(Department of Radiology,Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;Shenzhen Hengsheng Hospital,Shenzhen 518115,China;Department of Radiology,Central Hospital Affiliated to Dalian Medical University,Dalian 116033,China;Department of Gastroenterology,Central Hospital Affiliated to Dalian Medical University,Dalian 116033,China)

机构地区：[1]上海中医药大学附属市中医医院放射科,上海市200071 [2]深圳恒生医院放射科 [3]大连医科大学附属市中心医院放射科 [4]大连医科大学附属市中心医院普外科 [5]大连医科大学附属市中心医院消化内科

出　　处：《中国肿瘤临床》2023年第16期838-843,共6页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨计算机断层血管造影(computed tomography angiography,CTA)及计算机断层结肠成像(computed tomography colonography,CTC)及融合图像对腹腔镜直肠癌根治术的临床价值。方法:回顾性分析2012年2月至2019年2月大连医科大学附属市中心医院收治的100例经手术病理证实的接受腹腔镜直肠癌根治术患者的临床病例资料,50例为CTA-CTC融合组,50例为常规CT组。测量CTA-CTC融合组患者肠系膜下动脉起始处至分叉的距离及肿瘤远端至直肠末端的距离,对肿瘤的解剖定位、肠系膜下动脉分支走行及空间毗邻关系进行术前评估,并与术中所见进行对比。比较两组患者术中及术后恢复情况及3年总体生存率和3年无复发生存率。结果:肠系膜下动脉起始处至分叉距离及肿瘤远端至直肠末端的距离与术中测量数据差异无统计学意义(均P>0.05)。CTA-CTC融合图像能三维立体显示肿瘤解剖定位、肠系膜下动脉、左结肠动脉、直肠上动脉、乙状结肠动脉的走行,与术中所见一致。两组患者手术时间、术中出血量差异有统计学意义(t=−2.433,t=−2.346;均P<0.05)。两组患者淋巴结清扫数目、术中输血例数,术后并发症发生例数、术后通气时间、术后住院时间差异无统计学意义(均P>0.05)。两组患者3年总体生存率及无复发生存率差异无统计学意义(均P>0.05)。结论:CTA、CTC及融合图像可以清晰地显示直肠癌的解剖定位、肠系膜下动脉分支走行及空间毗邻关系,有利于手术医生准确地选择腹腔镜直肠癌根治术的手术方式和手术入路,缩短手术时间,减少术中出血量。Objective:To investigate the clinical value of multislice computed tomography angiography(CTA)and multislice computed tomography colonography(CTC)and fusion images in laparoscopic radical resection of rectal cancer.Methods:The clinicopathologic data of 100 patients who had undergone laparoscopic radical resection for surgically and pathologically confirmed rectal cancer at Central Hospital Affiliated to Dalian Medical University between February 2012 and February 2019 were retrospectively analyzed.The CTA-CTC and conventional CT groups included 50 cases each.The distance of the submesenteric artery from initiation to bifurcation and the distance of the distal end of the tumor to the end of the rectum were measured in the CTA-CTC fusion group.The anatomic location of the tumor,submesenteric artery branch,and spatial proximity relationship were preoperatively evaluated and compared to the intraoperative findings.The intraoperative and postoperative recovery,3-year overall survival rate,and 3-year recurrence-free survival rate were compared between the two groups.Results:There was no significant difference between the distance from the initiation to bifurcation of the inferior mesenteric artery and the distance from the distal end of the tumor to the end of the rectum(all P>0.05).The CTA-CTC fusion image showed the anatomical location of the tumor and the courses of the inferior mesenteric artery,left colic artery,superior rectum artery,and sigmoid artery in three dimensions,which was consistent with the intraoperative findings.The operative time and intraoperative blood loss were significantly different between the two groups(t=−2.433,t=−2.346,P<0.05).There was no significant difference in the numbers of lymph nodes dissected,intraoperative blood transfusions,and postoperative complications;postoperative ventilation time;and length of postoperative hospitalization duration between the two groups(all P>0.05).Additionally,the 3-year overall survival rate and relapse-free survival rate did not differ significantly

关 键 词：直肠癌 计算机断层增强扫描 计算机断层血管造影 计算机断层结肠成像 腹腔镜检查 

分 类 号：R735.37[医药卫生—肿瘤]