CT虚拟内镜精准肿瘤定位在腹腔镜中高位直肠癌根治术手术方案制定中的应用

The Value of CT Virtual Endoscopy in Pre-operative Planning of Laparoscopic Radical Resection for Rectal Cancer

目的探讨CT虚拟内镜三维重建左半结直肠的影像对在腹腔镜中高位直肠癌根治术前制定详细精准的手术方案的预测作用。方法将2017年6月至2018年10月我科收治的40例中高位直肠癌患者,术前利用CT虚拟内镜结肠重建来制定降结肠游离范围及肿瘤远、近端切除范围,并通过肠系膜下动脉CTA提前预判肠系膜下血管走行及变异。对比术前、术中所得数据并进行统计学分析,评估术前CT三维重建的准确性。结果40例患者左半结肠-直肠平均长度预测值为(68.3±7.5)cm,实际长度(68.2±6.6)cm,经配对t检验差异无统计学意义(t=0.562,P=0.725)。肠系膜左动脉发出部位距肠系膜下动脉根部距离术前评估为(3.84±0.78)cm,术中测定为(3.81±0.72)cm,差异无统计学意义(t=0.795,P=0.453)。术前预测左结肠动脉分型准确率为97.5%(39/40)。结论左半结肠CT虚拟内镜三维重建在中高位直肠癌术前精准定位中的应用,可作为中高位直肠癌术前手术方案制定的重要环节,提高手术效率及促进术后康复。

Objective To explore the predictive value of the reconstruction of three dimension model of left colon by CT virtual endoscopy in the operation planning before laparoscopic radical resection for rectal cancer.Methods Forty rectal cancer patients were selected who were operated with laparoscopic radical resection in the Zigong Fourth People's Hospital.These patients accepted CT virtual endoscopy examination and pre-operative planning.Three dimension model of left colon,rectum and inferior mesenteric artery were reconstructed before surgery.The data of preoperative and intra-operative index was compared to evaluate the accuracy of CT three-dimensional reconstruction.Results The preoperative and intra-operative index of the average length of left colon was(68.3±7.5)cm and(68.2±6.6)cm,with no statistic difference(t=0.562,P=0.725).The preoperative and intra-operative index of the average distance from the origin of left mesenteric artery to the root of inferior mesenteric artery was(3.84±0.78)cm and(3.81±0.72)cm,with no statistic difference(t=0.795,P=0.453).Conclusion CT virtual endoscopy can be one of the most important parts of the pre-operative planning of laparoscopic radical resection for rectal cancer patients and is favorable to the enhancement of operative efficiency and clinical effects.