多层螺旋CT血管重建技术对肠系膜血管的评估价值

Preoperative evaluation of multi-slice spiral computed tomography angiography in laparoscopic radical operation for colorectal carcinoma

目的探讨多层螺旋cT血管重建（MSCTA）技术对肠系膜血管的评估价值，为腹腔镜结直肠癌根治术中的血管解剖和游离提供参考。方法收集2013年10月至2015年3月间在广东省东莞市人民医院单一手术组接受腹腔镜结直肠癌根治性术、且术前行MSCTA检查的50例患者（MSCTA组）的临床资料。通过MSCTA对患者肠系膜血管的解剖和变异情况进行术前评估，并与术中所见进行对比。收集同期同一手术组所施行的50例腹腔镜结直肠癌根治术但术前未行MSCTA检查而仅行常规腹部平扫及增强CT检查的患者作为对照。比较两组患者术中及术后恢复情况。结果MSCTA能清晰地显示出肠系膜血管的解剖及变异情况，与术中所见的符合率为100％（50／50）。与常规cT组相比，MSCTA组患者手术时间明显缩短[（195D±23．2）min比（218．0±19．6）min，t=8．326，P=0．015），术中出血量明显减少[（168．1±18．8）ml比（206．5±14．3）ml，t=-19．369，P=0．002）。两组患者淋巴结清扫数目、术后并发症发生率、术后住院时间及住院费用的差异无统计学意义（均P〉0．05）。结论术前MSCTA技术能准确获悉肠系膜血管的走行及变异情况，从而有利于缩短腹腔镜结直肠癌术中血管裸化的时间，减少不必要的血管损伤出血。

Objective To investigate the clinical application of 256 multi-slice spiral computed tomography angiography （MSCTA） technique in the preoperative evaluation of mesenteric angiography in order to provide a reference to vessel anatomy and dissociation in laparoscopic radical operation for colorectal carcinoma. Methods Clinical data of 50 patients with colorectal cancer who underwent preoperative MSCTA＋FDCT and laparoscopic curative operation at our hospital from October 2013 to March 2015 were collected （MSCTA group）. The evaluation item was visualization of mesenteric artery, which was compared with the findings under laparoscopic surgery. Meanwhile, another 50 colorectal cancer patients undergoing laparoscopic radical operation by the same surgeon team without preoperative MSCTA examination were used as control （control group）. Clinical data were compared between the two groups. Results MSCTA precisely and correctly demonstrated anatomy and variations of the mesenteric artery and relative nutrient vessel in carcinoma. The angiography reconstruction images were consistent with the visual anatomy and variation from laparoscopic findings, whose diagnostic conformity rate of 100%. As compared to control group, operative time was shorter [ （195.0 ± 23.2） minutes vs.（218.0 ± 19.6） minutes, t = 8.326, P = 0.015 ], and blood loss was less [ （ 168.1 ±18.8 ） ml vs. （ 206.5 ±14.3 ） ml, t =-19.369, P= 0.002] in MSCTA group. Differences of number of harvested lymph node, postoperative complication morbidity, postoperative hospital stay and hospitalization cost were not significant betweentwo groups（all P 〉 0.05）. Conclusion Preoperative MSCTA can demonstrate anatomy and variations of the mesenteric artery precisely and correctly, thus it is beneficial to shorten the operation time and to reduce blood loss.