计算机体层摄影血管造影在腹腔镜结肠癌根治术前评估中的应用效果

Application efficacy of computed tomography angiography in preoperative evaluation for laparoscopic radical resection of colon cancer

摘要:

目的 分析计算机体层摄影血管造影（CTA）在腹腔镜结肠癌根治术前评估中的应用效果。方法 回顾性分析2021年1月－2024年2月于该院接受腹腔镜结肠癌根治术的120例患者的临床资料。其中，60例行常规腹部CT和CTA，60例行磁共振成像（MRI）。以术后病理为金标准，判断CTA对临床T分期与术后病理的一致性，以及评估肿瘤是否侵犯肠系膜血管和周围组织的准确度。结果 术前CTA诊断T分期的准确率为95.00%（57/60），一致性好（Kappa = 0.925，P < 0.05）；术前MRI诊断结肠癌T分期的准确率为98.33%（59/60），两者比较，差异无统计学意义（χ² = 0.26，P > 0.05）。CTA预判肿瘤是否累及肠系膜上动脉、肠系膜上静脉、肠系膜下动脉、肠系膜下静脉、腹主动脉、肾动脉、肾静脉和脾动脉等血管，与术后病理的一致性好。特别是在预测肠系膜血管受累方面，CTA的敏感度为94.44%，特异度为95.83%，准确度高达95.00%。结论 对于行腹腔镜结肠癌根治术的患者，术前CTA不仅能清晰地显示结肠癌T分期，还能揭示肠系膜血管的走行和变异，以及肿瘤与周围组织的关系和侵犯程度，从而为手术规划提供强有力的支持，确保了腹腔镜手术的安全性，减少了不必要的手术风险。

Abstract:

Objective To analyze the clinical application of computed tomography angiography (CTA) in preoperative planning for laparoscopic radical resection of cancer procedures.Methods Clinical data of 120 patients who underwent laparoscopic radical resection of colon cancer from January 2021 to February 2024 were retrospectively analyzed. Among them, 60 patients underwent routine abdominal CT and CTA, while the other 60 patients underwent magnetic resonance imaging (MRI). Pathological findings were used as the gold standard to determine the consistency of CTA in clinical T staging and actual results, as well as its accuracy in evaluating whether the tumor invaded the mesenteric blood vessels and surrounding tissues.Results Using pathological findings as the gold standard, preoperative CTA demonstrated 95.00% diagnostic accuracy (57/60) for T-staging, showing excellent agreement (Kappa = 0.925, P < 0.05). The preoperative MRI successfully diagnosed 98.33% (59/60) in determining the T staging of colon cancer. There was no significant difference in the number of cases detected by CTA and MRI (χ² = 0.26, P > 0.05). CTA predicted whether the tumor involved important blood vessels such as superior mesenteric artery, superior mesenteric vein, inferior mesenteric artery, inferior mesenteric vein, as well as surrounding tissues such as abdominal aorta, renal artery, renal vein and splenic artery, which was in good agreement with postoperative pathological results. Especially in predicting mesenteric vascular involvement, the sensitivity, specificity and accuracy of CTA were 94.44%, 95.83% and 95.00%, respectively.Conclusion Preoperative CTA for patients undergoing laparoscopic radical resection of colon cancer not only provides clear visualization of T-staging, but also reveals mesenteric vascular anatomy/variants and defines tumor relationships with surrounding structures. This comprehensive assessment offers robust support for surgical planning, enhances laparoscopic procedure safety, and reduces avoidable operative risks.