摘要
目的回顾性分析直肠癌患者行根治术前的直肠高分辨磁共振检查资料,观察患者直肠侧系膜结构并结合临床资料分析其对患者预后的影响.方法对2017年1月至2018年12月期间在海军军医大学第一附属医院行直肠癌根治术患者的数据进行回顾性分析.收集术前行直肠高分辨磁共振成像(MRI)的患者的影像学资料,根据MRI图像观察直肠系膜筋膜(MRF)双侧的直肠侧系膜结构及直肠中动脉(MRA)并测量相关参数,包含直肠侧系膜中断宽度、直肠中动脉类型和直肠中动脉最大管径,结合临床资料与患者无病生存(DFS)资料进行Cox回归分析,构建患者术前预测模型及绘制Nomogram图和(ROC)曲线.结果最终258例患者纳入本研究.术前直肠高分辨MRI中所有患者双侧均观察到MRF的中断及MRA走行.MRA可分为4种类型:前外侧型、外侧型、后外侧型、细小分支型.根据术后有无局部复发及远处转移将患者分为复发转移组和未复发转移组.多因素Cox回归分析结果发现右侧直肠中动脉最大管径(HR:3.042,95%CI:1.928~4.798,P<0.001)、mrT分期(HR:3.618,95%CI:1.223~10.705,P=0.021)和右侧侧系膜宽度(HR:1.001,95%CI:1.000~1.001,P=0.012)为患者术后复发转移的预测因素.Nomogram预测模型C-index指数为0.733(95%CI:0.686~0.781).1、3及5年DFS的AUC分别为0.784、0.808以及0.888.结论直肠高分辨MRI可观察到直肠侧系膜和直肠中动脉固有存在,右侧侧系膜中断宽度和右侧直肠中动脉最大管径是患者术后复发转移的危险因素.术中更好地处理直肠侧系膜,可能会为患者带来更好的预后,未来仍需要进一步研究.
Objective To retrospectively analyze the data of rectal high-resolution magnetic resonance examination before radical resection in patients with rectal cancer,observe the structure of lateral mesorectum and analyze its influence on the prognosis of patients combined with clinical data.Methods Data of patients who underwent radical resection at the First Affiliated Hospital of Naval Medical University between January 2017 and December 2018 were retrospectively analyzed.The imaging data of patients undergoing rectal high-resolution magnetic resonance imaging(MRI)before surgery were collected.The bilateral structures of the mesorectal fascia(MRF)and the middle rectal artery(MRA)were observed based on MRI,and measured its relevant parameters,including the width of the lateral mesorectum,the type of MRA and maximum diameter of MRA.Cox regression analysis was performed by combining the clinical data with the patient's disease-free survival(DFS)data.The preoperative prediction model was constructed and Nomogram and receiver operating characteristic(ROC)curves were plotted.Results This study included 258 patients.The interruption of MRF and the MRA through were observed bilaterally in all patients on preoperative rectal high-resolution MRI.MRA could be divided into 4 types:anterolateral type,lateral type,posterolateral type,and small branches type.Patients were divided into two groups according to whether local recurrence and distant metastasis occurred.Multivariate Cox regression analysis showed the maximum diameter of the right MRA(HR:3.042,95%CI:1.928~4.798,P<0.001)and mrT stage(HR:3.618,95%CI:1.223~10.705,P=0.021)and the width of right MRF(HR:1.001,95%CI:1.000~1.001,P=0.012)were predictors of postoperative recurrence and metastasis.The C-index of the Nomogram prediction model was 0.733(95%CI:0.686~0.781).The AUC for 1-,3-and 5-year DFS was 0.784,0.808 and 0.888,respectively.Conclusion The inherent presence of the MRF and the MRA could be observed by high-resolution rectal MRI.The width of the right MRF and the maximum diameter of the right MRA were prognostic factors for postoperative recurrence and metastasis.Better intraoperative management of the MRF may lead to better outcomes for patients,and further research is still needed in the future.
作者
臧书芹
陈巧玲
江思源
朱晓明
沈浮
王颢
张卫
邵成伟
Zang Shuqin;Chen Qiaoling;Jiang Siyuan;Zhu Xiaoming;Shen Fu;Wang Hao;Zhang Wei;Shao Chengwei(Department of Radiology,Changhai Hospital,Naval Medical University,Shanghai 200433,China;Department of Anorectal Surgery,Changhai Hospital,Naval Medical University,Shanghai 200433,China)
出处
《中华结直肠疾病电子杂志》
2024年第4期312-320,共9页
Chinese Journal of Colorectal Diseases(Electronic Edition)
关键词
直肠肿瘤
磁共振成像
直肠侧系膜
直肠中动脉
预后
Rectal neoplasms
Magnetic resonance imaging
Lateral mesorectum
Middle rectal artery
Prognosis
