摘要
目的研究腹腔镜超低位直肠癌括约肌间超低位直肠切除术(ISR)难度的骨盆影像解剖学。方法回顾性分析2019年12月至2024年1月行腹腔镜下ISR的101例超低位直肠癌患者资料。根据手术难度评分,分为高难度组41例,低难度组60例。SPSS 22.0分析数据。围手术期各项指标、骨盆测量数据等计量资料以(±s)表示,行独立样本t检验。淋巴结清扫数目用中位数(四分位间距)表示。合并基础病等计数资料采用χ^(2)检验;Logistics回归分析影响手术难度的因素。P<0.05表示差异有统计学意义。结果两组患者在手术时间、术中出血量、住院时间、并发症分级上差异有统计学意义(P<0.05);高难度组较低难度组在骶尾弧长SL(t=9.832,P=0.000)、骨盆出口前后径ADPO(t=-4.470,P=0.000)、骨盆入口前后径ADPE(t=-3.095,P=0.030)、中骨盆前后径ADMP(t=-3.442,P=0.000)、耻骨联合上下径SPD(t=-4.156,P=0.000)、坐骨结节间径IID(t=-2.043,P=0.044)指标比较上,均具有统计学意义。经Logistic回归分析显示,中骨盆前后径ADMP,坐骨结节间径IID为腹腔镜超低位直肠癌ISR的独立保护因素;骶尾弧长SL,男性骨盆特征为腹腔镜超低位直肠癌ISR的独立危险因素(P<0.05)。结论CT三维重建骨盆测量可预测手术难度,其中中骨盆前后径、坐骨结节间径越短,骶尾弧长越长,超低位直肠癌ISR手术难度越高。
Objective To stud y the imaging anatomy of the pelvis during laparoscopic ultra low rectal resection(ISR).Methods Data of 101 patients with ultra-low rectal cancer who underwent laparoscopic ISR from December 2019 to January 2024 were retrospectively analyzed.According to the surgical difficulty score,41 cases were divided into high difficulty group and 60 cases were divided into low difficulty group.SPSS 22.0 analyzed the data.Perioperative indicators,pelvimetry data and other measurement data were expressed as(±s),and independent sample t test was performed.The number of lymph node dissection was expressed as the median(interquartile).χ^(2) test was used for counting data combined with basic diseases.Logistics regression analysis of the factors affecting the difficulty of surgery.P<0.05 indicated that the difference was statistically significant.Results There were significant differences in operation time,intraoperative blood loss,hospital stay and complication grade between the two groups(P<0.05).Sacrococcygeal arc length SL(t=9.832,P=0.000),anterop osterior diameter of pelvic outlet ADPO(t=-4.470,P=0.000),anteroposterior diameter of pelvic entrance ADPE(t=-3.095,P=0.030),anteroposterior diameter of middle pelvis ADMP(t=-3.442,P=0.000),and anteroposterior diameter of pelvic outlet ADPO(t=-4.470,P=0.000)were observed in the advanced difficulty group.P=0.000),upper and lower diameter SPD of symphysis pubis(t=-4.156,P=0.000),intertubercular diameter IID(t=-2.043,P=0.044)were statistically significant.Logistic regression analysis showed that the anterior and posterior diameter of the middle pelvis and the interischial diameter IID were independent protective factors for ISR of laparoscopic ultra-low rectal cancer.Sacrococcygeal arc length SL and male pelvic characteristics were independent risk factors for ISR of laparoscopic ultra-low rectal cancer(P<0.05).Conclusion CT three-dimensional reconstructed pelviometry can predict the difficulty of surgery.The shorter the anteroposterior diameter of the middle pelvis and the diameter between the ischial tubercle,the longer the sacrococcygeal arc length,and the more difficult the operation of ISR for ultra-low rectal cancer.
作者
陈亮亮
郭磊
刘文思
金从稳
Chen Liangliang;Guo Lei;Liu Wensi;Jin Congwen(CT Room,Aきliated Hospital of West Anhui Health Vocational College,Liuan Aanhui Province 237000,China;Department 1 of General Surgery,Aきliated Hospital of West Anhui Health Vocational College,LiuanAanhui Province 237000,China)
出处
《中华普外科手术学杂志(电子版)》
2025年第3期305-308,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
2022年度安徽省卫生健康科研项目立项项目(AHWJ2022c034)。
关键词
超低位直肠肿瘤
经括约肌切除术
腹腔镜
CT三维骨盆测量
Ultra-Low Rectal Tumor
Intersphincteric Resection(ISR)
Laparoscopes
CT Thr ee-Dimensional Pelvis Measurement
作者简介
通信作者:陈亮亮,Email:CLL_1019@163.com。
