文章摘要

术前CT下骨盆测量及病理参数对腹腔镜下中低位直肠癌根治术手术难度的预测及预测系统的建立

作者: 1张 海鑫, 1苏 琪
1 中国医科大学附属盛京医院结直肠肛门外科,沈阳 110004
通讯: 苏 琪 Email: suq@sj-hospital.org
DOI: 10.3978/j.issn.2095-6959.2019.02.021

摘要

目的:探讨术前CT的骨盆测量解剖参数及病理参数对腹腔镜中低位直肠癌手术难度预测价值及相应预测评分系统建立。方法:纳入2014年10月至2018年4月于中国医科大学附属盛京医院结直肠肛门外科行腹腔镜直肠癌根治术的80例患者,通过对术前CT骨盆测量得到的解剖参数及病理参数进行单因素分析得到可能影响手术难度的因素,再将筛选出的危险因素进行logistic多因素分析,根据logistic回归分析特点对危险因素赋值,建立评分系统,再利用受试者工作曲线(receiver operating characteristic,ROC)评价该评分系统效能。结果:肿瘤位置、耻骨联合高度比中骨盆前后直径、耻骨联合高度比中骨盆棘突直径为手术操作难度的影响因素。通过以上述因素构建的评分系统,得分越高,困难程度越大。结论:更低的肿瘤位置及更深窄的骨盆可能会导致手术难度增加。相应的评分系统有助于术前对患者进行评估,选择合适的术式。
关键词: 腹腔镜;中低位直肠癌;手术难度;评分系统

Predictive value of pelvic anatomical parameters measured by preoperative CT and pathological parameters for the difficulties when performing laparoscopic rectal surgery for mid‑low rectal cancer and establishing a scoring system for predicting

Authors: 1ZHANG Haixin, 1SU Qi
1 Department of Colorectal and Anal Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, China

CorrespondingAuthor:SU Qi Email: suq@sj-hospital.org

Abstract

Objective: To evaluate the predictive value of pelvic anatomical parameters measured by preoperative CT and pathological parameters for the difficulties when performing laparoscopic rectal surgery for mid-low rectal cancer and establish a scoring system for predicting. Methods: We performed univariable analysis of anatomical parameters by preoperative CT and pathological parameters in 80 patients laparoscopic rectal surgery for mid-low rectal cancer in our department between October 2014 and February 2018. Multiple logistic regression was performed to identify risk factors that were subsequently scored. A scoring system was then established. ROC curve was used to evaluate the value of this scoring system. Results: The risk factors influencing the difficulty level of laparoscopic rectal surgery for mid-low rectal cancer included tumor location, the ratio of height of the pubic symphysis to anteroposterior diameter of the mid-pelvis, the ratio of height of the pubic symphysis to interspinous diameter. A higher score after establish scoring system by above factors was associated with a more difficult operation. Conclusion: Lower tumor location, deeper and narrower pelvis caused an increase in the difficulty of surgery. The establishment of the scoring system is helpful for the preoperative screening cases to choose the best Surgical method.
Keywords: laparoscopic; mid-low rectal cancer; difficulty of surgery; scoring system