基于术前MRI的盆底解剖参数对超低位直肠癌精准功能保肛手术时间的影响  

The impact of preoperative MRI-based pelvic floor anatomy parameters on the precision functional sphincter-preserving surgery time for ultra-low rectal cancer

作　　者：吴浩凡 刘元豪 张锋敏 张现中 朱金浩 黄嘉莹 刘忠臣 丁良福 庄成乐 Wu Haofan;Liu Yuanhao;Zhang Fengmin;Zhang Xianzhong;Zhu Jinhao;Huang Jiaying;Liu Zhongchen;Ding Liangfu;Zhuang Chengle(Department of Gastrointestinal Surgery,Shanghai Tenth People's Hospital,Tongji University School of Medicine,Shanghai 200072,China;Department of Gastrointestinal Surgery,Chongming Branch of Shanghai Tenth People's Hospital,Tongji University School of Medicine,Shanghai 202157,China)

机构地区：[1]同济大学医学院附属第十人民医院胃肠外科,上海200072 [2]同济大学医学院附属第十人民医院崇明分院胃肠外科,上海202157

出　　处：《中华结直肠疾病电子杂志》2024年第3期209-216,共8页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：上海市崇明区科委科技项目(CKY2021-30);上海市第十人民医院青年培育项目(YNCR2C014)。

摘　　要：目的本研究旨在利用术前磁共振成像(MRI),全面评估超低位直肠癌患者的盆底解剖结构,并探究预测超低位直肠癌精准功能保肛手术(PPS)时间的最佳解剖参数和相应参考值.方法对2020年3月至2023年8月进行PPS的患者进行回顾性分析.所有患者均于术前行MRI成像(T2加权成像),并进行盆腔解剖参数的测量和计算.采用线性回归分析手术时间的预测因素.根据盆腔解剖参数将患者分为两组,采用Mann-Whitney U检验,比较组间各人群特征差异.结果本研究共纳入136例超低位直肠癌患者.盆底肌深度(D)定义为两侧提肛肌与闭孔内肌接触位置连线的中点到两侧肛门直肠交界处连线的最短距离.多因素线性回归分析显示,高血压(标准回归系数=0.155,P=0.045)、淋巴结转移(标准回归系数=0.223,P=0.004)、盆底肌深度(标准回归系数=0.398,P<0.001)是手术时间的独立预测因素.基于Mann-Whitney U检验统计值的分析显示,D=25mm为最佳诊断截断值.与D<25 mm组的患者相比,D≥25 mm组的患者手术时间更长(240分钟vs.210分钟,P=0.005),既往腹部手术史比例更低(17.9%vs.34.5%;P=0.028),预防性造口比例呈增高趋势(25.6%vs.13.8%;P=0.091),但差异无统计学意义.除盆底解剖参数D外,两组间其他盆底解剖参数也存在显著差异.D 25 mm组患者的盆底解剖参数B更短(28 mm vs.23.5 mm;P=0.001),a、a'、β角度更大(50.4°vs.55.2°,P<0.001;47.5°vs.54.8°,P<0.001;48.9°vs.55°,P<0.001),但A、C等参数差异无统计学意义.结论盆底肌深度是评估超低位直肠癌精准功能保肛手术难度的有效术前预测因子.Objective This study aims to comprehensively assess the pelvic floor anatomy of patients undergoing surgery for ultra-low rectal cancer using preoperative magnetic resonance imaging(MRI)and explore the optimal anatomical parameters and corresponding reference values for predicting the surgical time of precision functional sphincter‑preserving surgery(PPS)for ultra-low rectal cancer.Methods A retrospective analysis was conducted on patients undergoing PPS for ultra-low rectal cancer from March 2020 to August 2023.All patients underwent preoperative MRI imaging(T2-weighted imaging),and pelvic anatomical parameters were measured and calculated.Linear regression analysis was used to identify predictive factors for surgical timing.Patients were divided into two groups based on pelvic anatomical parameters,and differences in demographic characteristics between groups were compared using the Mann-Whitney U test.Results A total of 136 patients with ultralow rectal cancer were included in this study.Pelvic floor muscle depth(D)was defined as the midpoint between the contact points of the levator ani muscles on both sides and the shortest distance to the line between the anorectal junctions.Multivariable linear regression analysis revealed that hypertension(standard regression coefficient=0.155,P=0.045),lymph node metastasis(standard regression coefficient=0.223,P=0.004),and pelvic floor muscle depth(standard regression coefficient=0.398,P<0.001)were independent predictive factors for surgical timing.Analysis based on the Mann-Whitney U test statistics showed that D=25 mm was the optimal diagnostic cutoff value.Compared to patients in the D<25 mm group,those in the D≥25 mm group had longer surgery durations(240 minutes vs.210 minutes,P=0.005),a lower proportion of previous abdominal surgeries(17.9%vs.34.5%;P=0.028),and a higher,though not statistically significant,trend in the proportion of prophylactic stoma formation(25.6%vs.13.8%;P=0.091).Apart from pelvic floor depth D,there were significant differences in other pe

关 键 词：直肠肿瘤 超低位直肠癌 磁共振成像 盆底解剖 经自然腔道取标本手术 精准功能保肛术 

分 类 号：R735.37[医药卫生—肿瘤]