多层螺旋CT血管造影三维重建在腹腔镜结直肠癌根治术中的价值研究
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摘要
目的:探讨多层螺旋CT(multi-slice spiral CT,MSCT)血管造影三维重建技术在腹腔镜结直肠癌根治术术前评估中的价值。方法:回顾性收集2016年3月—2018年3月行腹腔镜结直肠癌根治术的患者92例,根据术前是否行MSCT血管造影三维重建将患者分为重建组52例和非重建组40例。比较两组手术指标(术中出血量、手术时间及总淋巴结清扫数)和术后指标(首次肛门排气时间、腹腔引流量及住院时间),采用Kappa一致性检验分析重建组术前手术方案设计与实际手术方案的一致性。结果:重建组52例患者均顺利进行腹腔镜下结直肠癌根治术,术前MSCT血管造影三维重建对肠系膜主要血管均显示。重建组术中出血量、手术时间及腹腔引流量小于非重建组[(89.35±11.68) mL vs.(112.54±35.69)mL、(152.37±39.51)min vs.(193.35±62.73) min、(185.32±26.94) mL vs.(293.51±45.6) mL,P<0.05],淋巴结清扫数、首次肛门排气时间、住院时间与非重建组无差异[(31.62±11.95)个vs.(30.02±10.14)个、(2.41±0.93)d vs.(2.73±0.95) d、(9.05±1.82) d vs.(9.23±2.05) d,P>0.05]。47例患者MSCT血管造影三维重建拟定的手术方案与术中一致,符合率为90.38%(Kappa=0.829,P<0.05)。结论:术前MSCT血管造影三维重建有利于提高腹腔镜结直肠癌根治术的效率和安全性,通过三维重建拟定的手术方案对实际手术操作具有前瞻性指导价值。
Objective: To evaluate the value of three-dimensional reconstruction of multi-slice spiral CT(MSCT) angiography in preoperative evaluation of laparoscopic radical resection of colorectal cancer. Methods: A total of 92 cases with laparoscopic radical resection of colorectal cancer were collected from Mar. 2016 to Mar. 2018. They were divided into reconstruction group(n=52) and non-reconstruction group(n=40). The surgical indicators(intraoperative bleeding volume, operation time, total lymphatic clearance) and postoperative indicators(first anus exhaust time, abdominal drainage volume, and length of hospital stay) were compared. The Kappa conformance test was used to determine the consistency between preoperation plan and actual operation plan in reconstruction group. Results: All the patients in the reconstruction group underwent laparoscopic radical resection of colorectal cancer. Preoperative three-dimensional reconstruction of MSCT angiography showed the main mesenteric vessels. The intraoperative blood loss, operation time, and abdominal drainage volume in reconstruction group were lower than those in nonreconstruction group [(89.35±11.68) mL vs.(112.54±35.69) mL,(152.37±39.51) min vs.(193.35±62.73) min,(185.32±26.94)mL vs.(293.51±45.6) mL, P<0.05]. There was no significant difference in the number of resected lymph nodes, first anus exhaust time, and length of hospital stay between the two groups [(31.62±11.95) vs.(30.02±10.14),(2.41±0.93) d vs.(2.73±0.95) d,(9.05±1.82) d vs.(9.23±2.05) d, P>0.05]. The preoperative plan based on three-dimensional reconstruction of MSCT angiography in 47 cases was consistent with the actual operation plan. The coincidence rate was 90.38%(Kappa=0.829, P<0.05).Conclusion: Preoperative three-dimensional reconstruction of MSCT angiography is conducive to improve the e?ciency and safety of laparoscopic radical resection of colorectal cancer. The proposed surgical plan based on three-dimensional reconstruction has a prospective guiding value for the actual operation.
Objective: To evaluate the value of three-dimensional reconstruction of multi-slice spiral CT(MSCT) angiography in preoperative evaluation of laparoscopic radical resection of colorectal cancer. Methods: A total of 92 cases with laparoscopic radical resection of colorectal cancer were collected from Mar. 2016 to Mar. 2018. They were divided into reconstruction group(n=52) and non-reconstruction group(n=40). The surgical indicators(intraoperative bleeding volume, operation time, total lymphatic clearance) and postoperative indicators(first anus exhaust time, abdominal drainage volume, and length of hospital stay) were compared. The Kappa conformance test was used to determine the consistency between preoperation plan and actual operation plan in reconstruction group. Results: All the patients in the reconstruction group underwent laparoscopic radical resection of colorectal cancer. Preoperative three-dimensional reconstruction of MSCT angiography showed the main mesenteric vessels. The intraoperative blood loss, operation time, and abdominal drainage volume in reconstruction group were lower than those in nonreconstruction group [(89.35±11.68) mL vs.(112.54±35.69) mL,(152.37±39.51) min vs.(193.35±62.73) min,(185.32±26.94)mL vs.(293.51±45.6) mL, P<0.05]. There was no significant difference in the number of resected lymph nodes, first anus exhaust time, and length of hospital stay between the two groups [(31.62±11.95) vs.(30.02±10.14),(2.41±0.93) d vs.(2.73±0.95) d,(9.05±1.82) d vs.(9.23±2.05) d, P>0.05]. The preoperative plan based on three-dimensional reconstruction of MSCT angiography in 47 cases was consistent with the actual operation plan. The coincidence rate was 90.38%(Kappa=0.829, P<0.05).Conclusion: Preoperative three-dimensional reconstruction of MSCT angiography is conducive to improve the e?ciency and safety of laparoscopic radical resection of colorectal cancer. The proposed surgical plan based on three-dimensional reconstruction has a prospective guiding value for the actual operation.
引文
[1] SEHGAL R, CAHILL R A. Advanced laparoscopic surgery for colorectal disease:NOTES/NOSE or single port?[J]. Best Pract Res Clin Gastroenterol, 2014, 28(1):81-96.
[2]陈晓英,陈强,晏党,等.腹腔镜结直肠癌根治术前行多层螺旋CT血管造影三维重建的价值[J].中国临床研究,2017, 30(4):482-484, 488.
[3] PREVOT F, SABBAGH C, DEGUINES J B, et al. Are there any surgical and radiological correlations to the level of ligation of the inferior mesenteric artery after sigmoidectomy for cancer?[J]. Ann Anat, 2013, 195(5):467-474.
[4]谢锷,翁泽生,王小忠,等.术前多层螺旋CT血管成像检查对胃癌根治术的指导价值[J].中华胃肠外科杂志, 2011,14(1):31-33.
[5]赵欣,戎祯祥,潘壬清,等.多层螺旋CT血管造影术在结肠癌腹腔镜术前评估中的价值[J].中华腔镜外科杂志(电子版), 2012, 5(6):53-56.
[6]中华医学会外科学分会腹腔镜与内镜外科学组,中国抗癌协会结直肠癌专业委员会腹腔镜外科学组.腹腔镜结直肠癌根治手术操作指南(2008版)[J].中华胃肠外科杂志,2009, 12(3):310-312.
[7]杜燕夫,渠浩,李敏哲,等.腹腔镜直肠癌切除肠系膜血管裸化及左结肠动脉保留术[J].中华普外科手术学杂志(电子版), 2014, 8(2):138.
[8] SARLI L, PAVLIDIS C, CINIERI F G, et al. Prospective comparison of laparoscopic left hemicolectomy for colon cancer with laparoscopic left hemicolectomy for benign colorectal disease[J]. World J Surg, 2006, 30(3):446-452.
[9]马磊.腹腔镜下直肠癌根治术与传统开腹手术患者术后近期获益对比分析[J].中国煤炭工业医学杂志, 2016,19(1):46-49.
[10]张策,薛琪,李国新,等.腹腔镜右半结肠切除术相关血管的活体解剖学观察[J].中国临床解剖学杂志, 2012,30(3):256-259.
[11] CIROCCHI R, TRASTULLI S, FARINELLA E, et al. Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A Meta-analysis of randomized and non-randomized clinical trials[J]. Colorectal Dis, 2012, 14(9):e521-e529.
[12]杨强帮,戎祯祥,张浩,等.腹腔镜右半结肠癌D3根治术的术前MSCT三维重建观测指标的探讨[J].广东医学, 2016,37(18):2757-2759.
[13]王冠,滕磊磊,吴霁晖,等.多层螺旋CT血管造影技术在腹腔镜右半结肠手术前评估中的作用[J].中华胃肠外科杂志, 2011, 14(11):851-854.
[14]孙宏亮,王武,姚力,等. 256层螺旋CT对腹腔镜结直肠癌手术前肠系膜血管解剖结构评估的价值[J].中华胃肠外科杂志, 2011, 14(11):855-858.
[15]蔡恒烈,戎祯祥.腹腔镜左半结肠癌根治术前MSCT三维重建的临床价值[J].实用医学杂志, 2015, 31(5):788-790.
[2]陈晓英,陈强,晏党,等.腹腔镜结直肠癌根治术前行多层螺旋CT血管造影三维重建的价值[J].中国临床研究,2017, 30(4):482-484, 488.
[3] PREVOT F, SABBAGH C, DEGUINES J B, et al. Are there any surgical and radiological correlations to the level of ligation of the inferior mesenteric artery after sigmoidectomy for cancer?[J]. Ann Anat, 2013, 195(5):467-474.
[4]谢锷,翁泽生,王小忠,等.术前多层螺旋CT血管成像检查对胃癌根治术的指导价值[J].中华胃肠外科杂志, 2011,14(1):31-33.
[5]赵欣,戎祯祥,潘壬清,等.多层螺旋CT血管造影术在结肠癌腹腔镜术前评估中的价值[J].中华腔镜外科杂志(电子版), 2012, 5(6):53-56.
[6]中华医学会外科学分会腹腔镜与内镜外科学组,中国抗癌协会结直肠癌专业委员会腹腔镜外科学组.腹腔镜结直肠癌根治手术操作指南(2008版)[J].中华胃肠外科杂志,2009, 12(3):310-312.
[7]杜燕夫,渠浩,李敏哲,等.腹腔镜直肠癌切除肠系膜血管裸化及左结肠动脉保留术[J].中华普外科手术学杂志(电子版), 2014, 8(2):138.
[8] SARLI L, PAVLIDIS C, CINIERI F G, et al. Prospective comparison of laparoscopic left hemicolectomy for colon cancer with laparoscopic left hemicolectomy for benign colorectal disease[J]. World J Surg, 2006, 30(3):446-452.
[9]马磊.腹腔镜下直肠癌根治术与传统开腹手术患者术后近期获益对比分析[J].中国煤炭工业医学杂志, 2016,19(1):46-49.
[10]张策,薛琪,李国新,等.腹腔镜右半结肠切除术相关血管的活体解剖学观察[J].中国临床解剖学杂志, 2012,30(3):256-259.
[11] CIROCCHI R, TRASTULLI S, FARINELLA E, et al. Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A Meta-analysis of randomized and non-randomized clinical trials[J]. Colorectal Dis, 2012, 14(9):e521-e529.
[12]杨强帮,戎祯祥,张浩,等.腹腔镜右半结肠癌D3根治术的术前MSCT三维重建观测指标的探讨[J].广东医学, 2016,37(18):2757-2759.
[13]王冠,滕磊磊,吴霁晖,等.多层螺旋CT血管造影技术在腹腔镜右半结肠手术前评估中的作用[J].中华胃肠外科杂志, 2011, 14(11):851-854.
[14]孙宏亮,王武,姚力,等. 256层螺旋CT对腹腔镜结直肠癌手术前肠系膜血管解剖结构评估的价值[J].中华胃肠外科杂志, 2011, 14(11):855-858.
[15]蔡恒烈,戎祯祥.腹腔镜左半结肠癌根治术前MSCT三维重建的临床价值[J].实用医学杂志, 2015, 31(5):788-790.