直肠癌开腹低位前切除术手术难度影响因素的术前MRI评估

Preoperative MRI evaluation of the factors influencing open low anterior resection difficulty for rectal cancer

目的利用术前MRI评估直肠癌开腹低位前切除术手术难度的影响因素。方法回顾性收集确诊为直肠癌且行开腹低位前切除术联合预防性回肠造口术的病人54例,其中男34例,女20例,平均年龄(56.98±10.47)岁。病人均于术前1周内行盆腔MRI检查。分析病人的MRI测量指标、临床病理指标、手术难度指标。MRI测量指标包括坐骨棘间径、坐骨结节间径、盆腔入口前后径、盆腔出口前后径、盆腔深度、肠系膜脂肪面积(MFA)、肿瘤距肛缘距离;临床病理指标包括年龄、性别和肿瘤分期、肿瘤最大径;手术难度指标为手术时间和术中出血量。单因素分析采用Pearson或Spearman秩相关分析,并进行多因素线性回归分析,确定MRI测量指标、临床病理指标与手术难度的相关性。结果单因素相关分析结果显示,坐骨棘间径、盆腔深度、MFA和肿瘤距肛缘距离均与手术时间相关(均P<0.05),肿瘤最大径与术中出血量相关(P<0.05)。多因素相关分析结果显示,盆腔深度、MFA、肿瘤距肛缘距离是影响手术时间的主要因素(P<0.05),肿瘤最大径是影响术中出血量的主要因素(P<0.05)。结论术前MRI可以为直肠癌开腹低位前切除术手术难度的评估提供有用的指标。

Objective Aimed to analyze the factors influencing open low anterior resection difficulty for rectal cancer with preoperative magnetic resonance imaging(MRI).Methods All of 54 patients(34 males and 20 females,mean age 56.98±10.47 years)diagnosed with rectal cancer,who had undergone open low anterior resection combined with prophylactic ileostomy were recruited retrospectively.Pelvic MRI was performed within one-week before surgery.Preoperative MRI data,clinicopathological data,and indicators of operative diffculty were analyzed.The MRI data included interspinous diameter,intertuberous diameter,anteroposterior diameter of the pelvic inlet,anteroposterior diameter of the pelvic outlet,pelvic depth,mesorectal fat area(MFA),and tumor height(distance from the anal verge to the lower margin of the tumors).The clinicopathologic data included age,sex,tumor staging,and maximum tumor diameter.The intraoperative time and blood loss were used as indicators of operative difficulty.Pearson’s product moment correlation coefficient or Spearman’s rank correlation coefficient were used in univariate analyses,whereas multiple linear regression analysis was used in multivariate analyses,then the associations between surgical difficulty and MRI data or clinicopathological data were analyzed.Results Univariate analyses showed that the interspinous diameter,pelvic depth,MFA,and tumor height were significantly associated with operative time(all P<0.05),and the maximum tumor diameter was significantly associated with the intraoperative blood loss(P<0.05).Multivariate analyses showed that the depth of the pelvic cavity,MFA,and the tumor hight were the main factors that affected the operation time(P<0.05),and maximum tumor diameter was the main factor affecting the intraoperative blood loss(P<0.05).Conclusion Preoperative MRI can provide useful indices for evaluating the difficulty of open low anterior resection in patients with rectal cancer.