直肠癌根治术前三维CT血管成像评估肠系膜下动脉分型可行性研究

目的探讨应用三维CT重建技术评估直肠癌病人肠系膜下动脉(IMA)分型及其特点的可行性。方法回顾性分析2017年1月至2018年11月陆军军医大学大坪医院普外科收治的108例直肠癌病人的临床资料。术前通过三维CT重建技术获得IMA图像;根据IMA分支的不同特点对其分型;对比分析IMA各分型之间的差异及特点。测量IMA长度(LIMA)及IMA根部至腹主动脉分叉部的距离(DIMA);并分析LIMA、DIMA与临床资料的关系。结果 108例病人的IMA分型为:Ⅰ型53例(49.1%);Ⅱ型24例(22.2%);Ⅲ型18例(16.7%);Ⅳ型13例(12%)。单因素方差分析显示;不同IMA分型的病人在年龄、BMI、LIMA、DIMA、阳性淋巴结数目、术中出血量、术后住院时间方面的差异无统计学意义(P>0.05)。但Ⅱ型与Ⅰ型、Ⅲ型的LIMA差异有统计学意义(P=0.022、0.011)。LIMA为(5.7±2.0)cm;DIMA为(6.3±2.3)cm。结论直肠癌根治术前利用三维CT血管成像技术准确评估IMA分型及其走行路径;为直肠癌根治术中对IMA的处理及保留LCA提供导向作用。

Feasibility of using three-dimensional CT reconstruction to evaluate inferior mesenteric artery types before radical resection of rectal cancer

Feasibility of using three-dimensional CT reconstruction to evaluate inferior mesenteric artery types before radical resection of rectal cancer ZHENG Hui-chao，ZHANG Yong，TIAN Yue，et al. Department of Gastric & Colorectal Division，General Surgery，Daping Hospital of Army Military Medical University，Chongqing 400042，China
Corresponding author：TONG Wei-dong，E-mail：vdtong@163.com
Abstract Objective To explore the feasibility and value of using three-dimensional CT reconstruction to evaluate the inferior mesenteric artery (IMA) classification and its characteristics in rectal cancer patients. Methods The clinical data of 108 rectal cancer patients admitted in Department of General Surgery, Daping Hospital of Army Military Medical University from January 2017 to November 2018 were analyzed retrospectively. The IMA images obtained by three-dimensional CT reconstruction before the operation were reviewed，the IMA was typed according to the different characteristics of IMA branches, and compared and analyzed the differences and characteristics of each IMA type. The length of IMA and the distance from the root of IMA to the bifurcation of the abdominal aorta were measured，and their associations with clinical features were analyzed. Results Of the 108 cases，60 were male and 48 were female. The IMA was classified into four types, of which 53（49.1%）were type Ⅰ，24（22.2%）were type Ⅱ，18（16.7%）were type Ⅲ，and 13（12%） were type Ⅳ. Univariate ANOVA showed that there were no statistically significant differences in age，BMI，LIMA，DIMA，number of positive lymph nodes，intraoperative blood loss and postoperative hospital stay among the patients with different IMA types（P>0.05）. However，there was a statistically significant difference in IMA length between type II and type I or type Ⅲ（P=0.022 and 0.011，respectively）. The average IMA length（LIMA） was (5.7±2.0)cm，and the average distance（DIMA）between the root of IMA and the bifurcation of the abdominal aorta was （6.3±2.3）cm. Conclusion Three-dimensional CT angiography can be used before radical resection of rectal cancer to obtain the types of IMA branches and their pathways，so as to provide guidance for the treatment of IMA and preservation LCA in radical resection of rectal cancer.