173例低位直肠癌患者的骨盆解剖差异对腹腔镜ISR手术时间的影响  

Effect of pelvic anatomical differences in 173 patients with low rectal cancer on the duration of laparoscopic intersphincteric resection

作　　者：田顺化 胡恒 陈保祥 胡航[1] 江从庆[1] TIAN Shunhua;HU Heng;CHEN Baoxiang;HU Hang;JIANG Congqing(Department of Colorectal and Anal Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院结直肠肛门外科,武汉430071

出　　处：《医学新知》2024年第1期25-32,共8页New Medicine

基　　金：国家发展改革委、国家卫生健康委疑难病症诊治能力提升工程(肿瘤学)(ZLYNXM202012)。

摘　　要：目的 探索低位直肠癌患者骨盆解剖差异及对腹腔镜下内括约肌切除术(intersphincteric resection, ISR)手术时间的影响。方法 回顾性收集了武汉大学中南医院2017年1月—2022年12月接受腹腔镜ISR手术患者的临床数据。基于CT/MRI从轴位、矢状位、冠状位对骨盆入口、骨盆出口、骨盆深度等17种骨盆参数进行测量,并对男女性骨盆解剖进行比较分析,通过多元线性回归分析探索影响手术时间的因素。结果 共纳入173例低位直肠癌患者,其中男性107例(61.8%),女性66例(38.2%),患者平均年龄为(58.06±9.91)岁,BMI为(22.65±3.15)kg/m^(2),手术时间为(271.53±53.74)min。不同性别患者在骨盆入口、骨盆出口、骨盆深度等15项骨盆参数指标上差异具有统计学意义。多元线性回归分析显示,坐骨结节间距越小[95%CI(-25.554,-3.671),P=0.009]是男性患者手术时间延长的独立危险因素,骶深越浅[95%CI(-166.166,-33.894),P=0.004]、α角越小[95%CI(0.051,5.499),P=0.046]是女性患者手术时间延长的独立危险因素,而骶深越浅[95%CI(-95.657,-18.082),P=0.004]、β角越大[95%CI(0.258,7.048),P=0.035],δ角越小[95%CI(-6.034,-0.627),P=0.016]、坐骨结节间距越小[95%CI(-18.589,-2.511),P=0.010]、系膜脂肪面积越大(P=0.043)是低位直肠癌患者手术时间延长的独立危险因素。结论 低位直肠癌患者的骨盆解剖在不同性别间存在显著差异性,且影响腹腔镜ISR手术时间的解剖因素在不同性别患者中亦不相同,骶深、β角、δ角、坐骨结节间距、系膜脂肪面积是影响手术时间的独立危险因素。关注这些骨盆解剖差异,对指导临床决策和提高手术安全具有重要意义。Objective To exploring pelvic anatomical differences in patients with low rectal cancer and the effect on the duration of laparoscopic intersphincteric resection(ISR).Methods Clinical data from patients with low rectal cancer who underwent laparoscopic ISR from January 2017 to December 2022 in Zhongnan Hospital of Wuhan University were retrospectively collected.The 17 pelvic parameters such as pelvic inlet,pelvic outlet and pelvic depth etc.were measured from axial,sagittal and coronal positions based on CT/MRI.A comparative analysis of male and female pelvic anatomy was also performed to explore the factors affecting the duration of surgery through multiple linear regression.Results A total of 173 patients with low rectal cancer were included,of whom 107(61.8%)were male and 66(38.2%)were female,with a mean patient age of(58.06±9.91)years,BMI(22.65±3.15)kg/m^(2),operative time of(271.53±53.74)min.In the comparison of pelvic anatomical differences,the differences in 15 pelvic parameters such as pelvic inlet,pelvic outlet and pelvic depth were statistically significant between patients of different genders.Multiple linear regression analysis showed that the smaller intertuberous distance[95%CI(-25.554,-3.671),P=0.009]was an independent risk factor for longer operative time in male patients.The shallower sacral depth[95%CI(-166.166,-33.894),P=0.004]and larger angleα[95%CI(0.051,5.499),P=0.046]were independent risk factors for prolonged operative time in female patients.Shallower sacral depth[95%CI(-95.657,-18.082),P=0.004],larger angleβ[95%CI(0.258,7.048),P=0.035],smaller angleδ[95%CI(-6.034,-0.627),P=0.016],smaller interberous distance[95%CI(-18.589,-2.511),P=0.010]and larger mesorectal fat area(P=0.043)were independent risk factors for prolonged operative time in patients with low rectal cancer.Conclusion The pelvic anatomy of patients with low rectal cancer differs significantly between genders,and anatomical factors affecting the duration of laparoscopic ISR vary among patients of different genders.Sacral

关 键 词：低位直肠癌 内括约肌切除术 骨盆测量 手术时间 

分 类 号：R735.37[医药卫生—肿瘤]