背景:持续下降结肠系膜(PDM)对乙状结肠癌和直肠癌(SRC)的诊断标准和效果仍存在争议。本研究旨在阐明PDM患者的放射学特征和短期手术结果。
方法:从2020年1月至2021年12月,使用多平面重建(MRP)和最大强度投影(MIP)对845例连续患者的放射学影像学数据进行了回顾性分析。PDM被定义为其中降结肠的右边缘位于左肾门的内侧的病症。使用倾向得分匹配(PSM)来最小化数据库偏差。将PDM患者的解剖特征和手术结果与非PDM患者的解剖特征和手术结果进行了比较。
结果:32例PDM患者和813例非PDM患者被纳入研究,他们接受了腹腔镜切除术。1:4匹配后,患者分为PDM组(n=27)和非PDM组(n=105).肠系膜下动脉(IMA)到肠系膜下静脉的长度(1.6cmvs.2.5cm,p=0.001),IMA至边缘动脉弓(2.7cmvs.8.4cm,p=0.001),和IMA到结肠(3.3厘米vs.10.2cm,p=0.001),PDM组明显短于非PDM组。转换为开放手术(11.1%vs.0.9%,p=0.008),手术时间(210分钟vs.163分钟,p=0.001),术中失血量(50mlvs.30ml,p=0.002),边缘足弓损伤(14.8%vs.0.9%,p=0.006),脾曲自由(22.2%vs.3.8%,p=0.005),哈特曼手术(18.5%vs.0.0%,p<0.001)和吻合失败(18.5%vs.0.9%,p=0.001)在PDM组中明显更高。此外,PDM是手术时间延长(OR=3.205,p=0.004)和吻合失败(OR=7.601,p=0.003)的独立危险因素。
结论:PDM是SRCs手术时间延长和吻合失败的独立危险因素。使用MRP和MIP进行术前放射学评估可以帮助外科医生更好地处理这种罕见的先天性变异。
BACKGROUND: The diagnostic criteria and effect of persistent descending mesocolon (PDM) on sigmoid and rectal cancers (SRCs) remain controversial. This study aims to clarify PDM patients\' radiological features and short-term surgical results.
METHODS: From January 2020 to December 2021, radiological imaging data from 845 consecutive patients were retrospectively analyzed using multiplanar reconstruction (MRP) and maximum intensity projection (MIP). PDM is defined as the condition wherein the right margin of the descending colon is located medially to the left renal hilum. Propensity score matching (PSM) was used to minimize database bias. The anatomical features and surgical results of PDM patients were compared with those of non-PDM patients.
RESULTS: Thirty-two patients with PDM and 813 patients with non-PDM were enrolled into the study who underwent laparoscopic resection. After 1:4 matching, patients were stratified into PDM (n = 27) and non-PDM (n = 105) groups. The lengths from the inferior mesenteric artery (IMA) to the inferior mesenteric vein (1.6 cm vs. 2.5 cm, p = 0.001), IMA to marginal artery arch (2.7 cm vs. 8.4 cm, p = 0.001), and IMA to the colon (3.3 cm vs. 10.2 cm, p = 0.001) were significantly shorter in the PDM group than those in the non-PDM group. The conversion to open surgery (11.1% vs. 0.9%, p = 0.008), operative time (210 min vs. 163 min, p = 0.001), intraoperative blood loss (50 ml vs. 30 ml, p = 0.002), marginal arch injury (14.8% vs. 0.9%, p = 0.006), splenic flexure free (22.2% vs. 3.8%, p = 0.005), Hartmann procedure (18.5% vs. 0.0%, p < 0.001) and anastomosis failure (18.5% vs. 0.9%, p = 0.001) were significantly higher in the PDM group. Moreover, PDM was an independent risk factor for prolonged operative time (OR = 3.205, p = 0.004) and anastomotic failure (OR = 7.601, p = 0.003).
CONCLUSIONS: PDM was an independent risk factor for prolonged operative time and anastomotic failure in SRCs surgery. Preoperative radiological evaluation using MRP and MIP can help surgeons better handle this rare congenital variant.