三维CT重建技术指导腹腔镜下直肠癌根治术中保留左结肠动脉的临床研究  

Clinical study of three-dimensional CT reconstruction technology guiding preserving the left colonic artery during laparoscopic radical resection of rectal cancer

作　　者：欧阳骏峰 付焱[1] 沈文强 胡欲飞 OUYANG Jun-feng;FU Yan;SHEN Wen-qiang;HU Yu-fei(Fourth Ward of General Surgery,Taihe Hospital,Shiyan Hubei 442000,China)

机构地区：[1]十堰市太和医院普外四病区,湖北十堰442000

出　　处：《局解手术学杂志》2025年第1期58-61,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的 探讨术前行全腹部三维CT重建指导腹腔镜下直肠癌根治术中保留左结肠动脉的意义及临床应用价值。方法 选取2021年1月至2022年1月于我院行腹腔镜下直肠癌根治术的直肠癌患者为研究对象,术前均行全腹部三维CT重建,筛选出均有左结肠动脉的87例患者,随机分为观察组(术中低位结扎肠系膜下动脉,保留左结肠动脉)40例和对照组(术中高位结扎肠系膜下动脉,不保留左结肠动脉)47例。比较2组患者围术期指标及术后病理结果。结果 观察组患者术中出血量高于对照组,手术时间长于对照组,差异均有统计学意义(P<0.05)。观察组患者术后肠梗阻及吻合口漏发生率低于对照组,术后首次排气时间早于对照组,差异均有统计学意义(P<0.05)。2组患者在肿瘤分化程度、肿瘤大小、腺癌分型、肠系膜下动脉根部淋巴结清扫数目、肿瘤侵犯肠壁深度分期方面差异均无统计学意义(P>0.05)。结论 术前行全腹部三维CT重建可预先了解肠系膜下动脉的分支分型情况,确定肿瘤位置及其与周围组织的毗邻关系,明确肠段切除范围;术中保留左结肠动脉能减少患者术后并发症的发生,具有积极的临床意义。Objective To investigate the significance and clinical value of preoperative three-dimensional CT reconstruction of the whole abdomen guiding preserving the left colonic artery during laparoscopic radical resection of rectal cancer.Methods Patients with rectal cancer who underwent laparoscopic radical resection of rectal cancer in our hospital from January 2021 to January 2022 were selected,then 87 patients with left colonic artery were screened out through three-dimensional CT reconstruction of the whole abdomen before surgery,who were randomly divided into the observation group(received intraoperative low ligation of the inferior mesenteric artery,with preservation of the left colonic artery) with 40 cases and the control group(received intraoperative high ligation of the inferior mesenteric artery without preservation of the left colonic artery) with 47 cases.The perioperative indexes and postoperative pathological results of the two groups were compared.Results The intraoperative blood loss in the observation group was higher than that in the control group,and the operation time was longer than that in the control group,with statistically significant differences(P<0.05).The incidences of postoperative intestinal obstruction and anastomotic leakage in the observation group were lower than those in the control group,and the first postoperative discharge time was earlier than that in the control group,with statistically significant differences(P<0.05).There was no significant difference in the degree of tumor differentiation,tumor size,adenocarcinoma classification,number of lymph nodes dissected at the root of the inferior mesenteric artery,or the stage of intestinal wall invasion depth of tumor between the two groups(P>0.05).Conclusion The application of the threedimensional CT reconstruction of the whole abdomen before surgery can understand the branch classification of the inferior mesenteric artery in advance,determine the location of the tumor and its adjacent relationship with the surrounding tissues,and

关 键 词：直肠恶性肿瘤 左结肠动脉 高位结扎 低位结扎 吻合口漏 三维CT重建 

分 类 号：R735.37[医药卫生—肿瘤]