左半结肠癌肝转移灶分布与门静脉系统解剖关系的研究

Study on the relationship between the distribution of liver metastases from left colon cancer and the anatomy of portal vein system

目的对左半结肠癌肝转移患者肝脏转移灶分布情况及其门静脉(PV)系统三维结构进行回归分析,获取一种可通过PV三维结构影像预测左半结肠癌患者肝脏转移灶分布情况的策略。方法收集2015—2020年间就诊于辽宁省肿瘤医院肝胆胰外科且明确诊断为左半结肠癌肝转移患者资料,最终共纳入符合标准患者90例。应用3D Slicer4.11对患者上腹部增强CT检查影像资料的DICOM文件进行肝脏PV系统的三维重建,获得PV系统的解剖结构。根据时间先后将患者分为建模组65例,验证组25例。利用Logistic回归模型对建模组进行单因素和多因素分析,预测PV解剖结构与左半结肠癌肝转移灶分布的相关性。利用ROC曲线评估预测模型对左半结肠癌肝转移灶分布趋势的诊断能力。应用25例验证组验证该预测模型的预测能力。结果90例患者中男61例、女29例。通过PV期增强CT三维重建共得到7种PV系统结构分型,其中PV主干在肝门处分出PV左支和PV右支,并且在肠系膜下静脉(IMV)汇入肠系膜上静脉(SMV),即A1B3分型占比最高60%(54/90)。结论PV系统解剖结构复杂多变;单纯使用IMV与SMV夹角、PV左右支夹角、PV右前支右后支夹角可以对左半结肠癌肝转移灶的分布趋势做出预测。联合IMV与SMV夹角、PV左右支夹角以及联合SMV夹角、PV左右支夹角、PV右前支右后支夹角对左半结肠癌肝转移灶的分布进行预测也有意义。

Objective To conduct regression analysis on the distribution of liver metastases and the three-dimensional structure of portal vein system in patients with left hemicolon cancer with liver metastases,so as to obtain a strategy that can predict the distribution of liver metastases in patients with left hemicolon cancer by using the three-dimensional structure image of portal vein.Methods Patients admitted to the hepatobiliary and pancreatic surgery department of Liaoning Provincial Cancer Hospital from January 2015 to October 2020 and clearly diagnosed as hepatic metastasis of left colon cancer were collected.Eventually were included in the standard for 90 cases of patients,application of 3 dslicer 4.11 on the people included in the standard of epigastric enhancement CT image data of DICOM files to hepatic portal venous system of 3D reconstruction,get the anatomic structure of portal venous system.According to the time we have divided the patients into model group,a total of 65 patients,and validation group a total of 25 patients.Univariate analysis and multivariate Logistic regression analysis were used to analyze the modeling group,to predict the correlation between portal vein anatomical structure and the distribution of liver metastasis of the left semicolon cancer,and ROC curve was used to evaluate the diagnostic ability of the prediction model for the distribution trend of liver metastasis of the left semicolon cancer.A validation group of 25 additional patients was used to verify the predictive power of the predictive model.Results A total of 90 patients,61 cases of male,29 cases female.90 patients with portal vein phase enhanced CT three-dimensional reconstruction,a total of seven kinds of portal venous system structure classification.Among the main portal vein in hepatic door disposal vein left and right portal vein branch and inferior mesenteric veins into the superior mesenteric vein,parting accounted for up to 60%(54/90).Conclusions The anatomical structure of portal vein system is complex and changeable.The Angle between the inferior mesenteric vein and superior mesenteric vein,the Angle between the left and right portal veins,and the Angle between the right anterior portal vein and the right posterior portal vein can be used to predict the distribution trend of liver metastasis of the left colon carcinoma.The combined Angle of inferior mesenteric vein and superior mesenteric vein,the Angle of left and right portal vein,the Angle of left and right portal vein,the Angle of right and right anterior portal vein and the Angle of right and back portal vein were also significant to predict the distribution of liver metastasis of left colon cancer.