高分辨率磁共振成像辅助腹腔镜低位直肠癌手术的效果分析

Analysis of the effect of high-resolution magnetic resonance imaging assisted laparoscopic surgery for low rectal cancer

摘要:

目的 分析高分辨率磁共振成像（MRI）辅助腹腔镜低位直肠癌的手术效果。方法 回顾性分析2018年1月－2020年1月该院收治的118例低位直肠癌患者的临床资料，所有患者均采用腹腔镜手术治疗，术前行高分辨率MRI检查的为MRI组（n = 52），术前未行高分辨率MRI检查的为非MRI组（n = 66）。以术后病理检查结果为金标准，比较高分辨率MRI检查对低位直肠癌患者T分期、N分期和环周切缘受累的诊断效果，并比较两组患者围手术期各指标和排便情况。结果 高分辨率MRI T分期的诊断率为84.62%（44/52）。其中，T₁期和T₄期的诊断正确率为100.00%；T₂期诊断正确率为85.71%（18/21），误诊的3例为T₃期，为过低分期；T₃期诊断正确率达77.27%（17/22），误诊的5例为T₂期，为过高分期。高分辨率MRI N分期的诊断率为73.08%（38/52）。其中，N₀期诊断正确率达66.67%（16/24），误诊的8例为N₁期，为过低分期；N₁期诊断正确率达71.43%（15/21），误诊的6例有5例为N₀期（过高分期），1例为N₂期（过低分期）；N₂期7例诊断正确率达100.00%。高分辨率MRI对环周切缘受累的诊断率为94.23%（49/52）。其中，环周切缘未受累与环周切缘受累诊断正确率达100.00%。MRI组患者的手术时间、第1次排便时间和每次排便时间短于非MRI组，术中出血量和日排便次数少于非MRI组，差异均有统计学意义（P < 0.05）。结论 高分辨率MRI能够较好地诊断低位直肠癌患者的T分期、N分期和环周切缘受累情况，并可缩短腹腔镜的手术时间，减少术中出血量，改善术后排便情况。

Abstract:

Objective To analyze the effect of high-resolution magnetic resonance imaging (MRI) assisted laparoscopic surgery for low rectal cancer.Methods Clinical data of 118 patients with low rectal cancer from January 2018 to January 2020 were retrospectively analyzed. Among them, all the patients were treated with laparoscopic surgery, 52 patients underwent high-resolution MRI examination before operation in MRI group, and the remaining 66 cases had no preoperative high-resolution MRI in non-MRI group. The postoperative pathological examination results were used as the gold standard to compare the diagnostic effects of high-resolution MRI on T stage, N stage, and peripheral margin involvement in patients with low rectal cancer, and compare the perioperative stages of patients in the MRI group and non-MRI group indicators and bowel movements.Results The diagnostic rate of T staging with high resolution MRI was 84.62% (44/52). Among of them, the diagnostic accuracy of T₁ and T₄ was 100.00%; The correct diagnostic rate in T₂ stage was 85.71% (18/21), and 3 cases were misdiagnosed as T₃ stage, which was too low stage. The correct rate of T₃ stage was 77.27% (17/22), and 5 cases were misdiagnosed as T₂ stage, which was too high stage. The diagnostic rate of N staging with high resolution MRI was 73.08% (38/52). Among of them, the correct diagnostic rate of N₀ stage was 66.67% (16/24), and 8 cases were misdiagnosed as N₁ stage, which was too low stage. The correct diagnostic rate of N₁ stage was 71.43% (15/21), and 6 misdiagnosed patients were 5 patients with N₀ stage (excessive stage) and 1 patient with N₂ stage (low stage). The diagnostic accuracy of 7 patients with N₂ stage was 100.00%. The diagnostic rate of peripheral margin involvement with high resolution MRI was 94.23% (49/52). Among of them, the accuracy of peripheral margin involvement and uninvolved peripheral margin was 100.00%. The operation time, intraoperative blood loss, first defecation time, each defecation time and daily defecation frequency of patients in MRI group were all less than those in non-MRI group, the difference is statistically significant (P < 0.05).Conclusion High-resolution MRI can better diagnose the T stage, N stage, and peripheral margin involvement in patients with low rectal cancer. It can shorten the intraoperative time of laparoscopic surgery, reduce intraoperative blood loss, and improve postoperative defecation.