Relationships of preoperative MRI pelvimetry with operating time and blood loss during laparoscopic anterior resection of rectal cancer
Objective To observe the pelvic and intrapelvic soft tissue parameters measured by MRI before laparoscopic anterior resection in both male and female patients with rectal cancer,and to investigate their relationships with intraoperative blood loss and operating time.Methods The clinical data of 44 patients with rectal cancer who underwent laparoscopic anterior resection in Henan Provincial People's Hospital from January to December 2022 were retrospectively analyzed.The MRI pelvic parameters included the anteroposterior diameter of pelvic entrance,anteroposterior diameter of pelvic outlet,pelvic depth,sacrococcygeal length,sacrococcygeal depth,upper and lower diameter of pubic symphysis,bispinous diameter,biischial diameter,α angle,β angle,γ angle,δ angle,θ angle,and e angle.The MRI intrapelvic soft tissue parameters included the mesorectal fat area(MFA)and mesorectal fat ratio(MFR).The pelvic parameters,intrapelvic soft tissue parameters,operating time and intraoperative blood loss were compared between 30 male patients and 14 female patients.Pearson and Spearman correlation methods were used to analyze the correlations of pelvic parameters,intrapelvic soft tissue parameters,age,gender,body mass index,T stage,N stage,distance from the lower edge of the tumor to the anal verge and tumor diameter with the operating time and intraoperative blood loss.Univariate and multiple linear regression analyses were used to assess the influencing factors of operating time and intraoperative blood loss of laparoscopic anterior resection.Results(1)The anteroposterior diameter of the pelvic entrance,bispinous diameter and biischial diameter were shorter in male patients[(11.80±0.86),(9.57±0.76),(10.15±1.05)cm]than those in female patients[(12.81±1.06),(11.52±0.66),(12.65±0.77)cm](P＜0.05).The α and γ angles were smaller in male patients[(86.13±6.34)°,(104.70±10.26)°]than those in female patients[(91.03±6.57)°,(116.56±12.37)°](P＜0.05).The pelvic depth,sacrococcygeal length and upper and lower diameter of pubic symphysis were longer in male patients[(11.17±0.92),(13.00±1.24),(5.10±0.37)cm]than those in female patients[(10.22±0.88),(11.77±0.93),(4.70±0.36)cm](P＜0.05).The β,δ and θ angles were larger in male patients[(123.46±8.82)°,(45.65±7.29)°,(98.33±5.87)°]than those in female patients[(115.27±12.71)°,(37.20±4.79)°,(90.49±6.09)°](P＜0.05).There were no significant differences in the anteroposterior diameter of pelvic outlet,sacrococcygeal depth,ε angle,MFA,MFR,operating time,and intraoperative blood loss between male and female patients(P＞0.05).(2)The β angle,sacrococcygeal length,MFA and MFR were positively correlated with the operating time(r=0.311,P=0.040;r=0.362,P=0.016;r=0.381,P=0.011;r=0.347,P=0.021),and the anteroposterior diameter of pelvic entrance,anteroposterior diameter of pelvic outlet,sacrococcygeal depth,pelvic depth,upper and lower diameter of pubic symphysis,bispinous diameter,biischial diameter,α angle,γ angle,δ angle,θ angle and ε angle were not correlated with the operating time(P＞0.05).The pelvic parameters and intrapelvic soft tissue parameters were not correlated with intraoperative blood loss(P＞0.05).The body mass index was positively correlated with the operating time(r=0.363,P=0.016).The distance from the lower edge of the tumor to the anal verge was negatively correlated with the operating time(r=-0.363,P=0.015).The age,gender,T stage,N stage and tumor diameter were not correlated with the operating time(P＞0.05).The tumor diameter was positively correlated with the intraoperative blood loss(r=0.532,P＜0.001).The distance from the lower edge of the tumor to the anal verge was negatively correlated with the intraoperative blood loss(r=-0.340,P=0.024).The age,gender,body mass index,T stage and N stage were not correlated with the intraoperative blood loss(P＞0.05).(3)The β angle(β=1.226,95％CI:0.161-2.291,P=0.025),MFA(β=3.042,95％CI:0.978-5.105,P=0.005),and the distance from the lower edge of the tumor to the anal verge(β=-6.511,95％CI:-10.726 to-2.296,P=0.003)were the influencing factors of operating time.The tumor diameter(β=17.281,95％CI:8.340-26.221,P＜0.001)and the distance from the lower edge of the tumor to the anal verge(β=-4.010,95％CI:-7.800 to-0.220,P=0.039)were the influencing factors of intraoperative blood loss.Conclusions The β angle,MFA,and the distance from the lower edge of the tumor to the anal verge influence the operating time of laparoscopic anterior resection of rectal cancer,and the tumor diameter and the distance from the lower edge of the tumor to the anal verge influence the intraoperative blood loss.To measure the pelvicβ angle and MFA by MRI before operation contributes to the evaluation of the difficulties of operation.
rectal cancerlaparoscopic anterior resectionMRImesorectal fat areaintraoperative blood lossoperating time
NETL
NSTL
万方数据
