基于MRI骨盆测量参数预测机器人辅助全直肠系膜切除术治疗中低位直肠癌的手术难度  

Measurement of pelvic parameters by magnetic resonance imaging to predict surgical difficulty of robot-assisted total mesorectal excision for mid and low rectal cancer

作　　者：韩明宇 段小飞[1] 周全博[1] 袁维堂[1] 连玉贵 Han Mingyu;Duan Xiaofei;Zhou Quanbo;YuanWeitang;Lian Yugui(Department of Colorectal and Anal Surgery,the First Afiliated Hospital of Zhengzhou University,Zhengzhou450052,China)

机构地区：[1]郑州大学第一附属医院结直肠肛门外科,郑州450052

出　　处：《中华胃肠外科杂志》2024年第8期824-832,共9页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(U2004112)。

摘　　要：目的:评估由经验丰富的结直肠外科医生进行机器人辅助全直肠系膜切除术(TME)情况下骨盆测量参数与手术难度之间的关系并构建列线图模型。方法:采用回顾性观察性研究方法。病例纳入标准:(1)肿瘤距肛缘≤10 cm;(2)术前病理检查证实为直肠癌;(3)术前具有完整的MRI影像学资料,评估肿瘤浸润深度为T1~3、环周切缘阴性且可达R 0切除。排除标准:(1)骨盆骨折病史;(2)骨盆手术史;(3)因肿瘤导致肠梗阻、肠穿孔等行急诊手术。依据上述标准,共纳入2021年1月至2022年12月于郑州大学第一附属医院结直肠肛门外科行机器人辅助TME手术治疗中低位直肠癌的82例患者构建预测模型(建模组),并收集2023年1-8月于同一中心行机器人辅助TME手术的35例中低位直肠癌患者资料用于模型的验证(验证组)。骨盆测量参数包括骨盆入口直径、骨盆出口直径、耻骨结节高度、骶骨高度、骶骨深度、坐骨棘间距、坐骨结节间距、直肠左右系膜跨度、直肠前后系膜跨度、直肠前系膜厚度、直肠后系膜厚度、直肠肠腔面积和直肠系膜面积等13项指标。本研究以手术时长作为评价手术困难程度的指标,手术时长定义为从切皮开始到关腹结束这一时间段,对与手术时长相关的变量进行分析。通过单因素和多因素logistic回归分析困难手术相关的危险因素,并建立预测困难手术的列线图模型。使用受试者工作曲线(ROC曲线)和校准曲线验证列线图的预测能力。并采用验证集数据作为本列线图的外部验证。结果:建模组82例患者包括54例男性和28例女性。中位年龄为61.0岁,中位体质指数为23.7 kg/m^(2),距肛门缘的中位距离为6.1 cm,中位肿瘤长径为4.5 cm。其中14例患者接受术前新辅助治疗,12例患者有腹部手术史。验证组35例患者包括24例男性和11例女性,中位年龄为64.0岁,中位体质指数为23.7 kg/m^(2),距肛门缘的中�Objective:To evaluate the relationship between pelvimetric parameters and surgical difficulty in robot-assisted total mesorectal excision(TME)performed by experienced colorectal surgeons,and to build a nomogram model.Methods:This was a retrospective observational study.The inclusion criteria were as follows:(1)tumor within 10 cm of the anal verge;(2)cancer confirmed by pathological examination of the postoperative specimen;(3)preoperative complete magnetic resonance imaging(MRI)data available;(4)depth of tumor invasion T1-3;(5)circumferential resection margin assessed as negative by MRI;and(6)R0 resection achieved.The exclusion criteria comprised(1)history of pelvic fractures;(2)history of pelvic surgery;and(3)emergency required because of tumor-related intestinal obstruction and/or perforation.Application of above criteria yielded 82 patients who had undergone robot-assisted total mesorectal excision of mid and low rectal cancer in the Department of Colorectal Surgery of the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2022(modeling group).Additionally,data of 35 patients with mid and low rectal cancer who had undergone robotic-assisted TME at the same center in 2023 January–August were collected for validation of the model(validation group).The following 13 pelvic parameters were studied:pelvic inlet diameter,pelvic outlet diameter,pubic tubercle height,sacral height,sacral depth,interspinous distance,inter-tuberosity distance,lateral mesorectal span,anterior-posterior mesorectal span,anterior mesorectal thickness,posterior mesorectal thickness,rectal area,and mesorectal area.Operating time was used as an indicator of the degree of surgical difficulty,this being defined as the time from the start of skin incision to the end of abdominal closure.Variables related to the duration of surgery were subjected to univariate and multivariate logistic regression analyses to identify factors associated with the difficulty of TME,after which a nomogram for predicting the difficulty of

关 键 词：直肠肿瘤 机器人手术 骨盆测量参数 全直肠系膜切除术 手术难度 

分 类 号：TP242[自动化与计算机技术—检测技术与自动化装置] R735.37[自动化与计算机技术—控制科学与工程]