检查测量直肠上静脉和肠系膜下静脉直径变化评估局部进展期直肠癌新辅助治疗效果的应用价值

朱海桃; 魏正强; 黄旺; 陈贞舟

doi:10.3760/cma.j.issn.1673-9752.2019.08.016

检查测量直肠上静脉和肠系膜下静脉直径变化评估局部进展期直肠癌新辅助治疗效果的应用价值

Application value of diameter change of superior rectal vein and inferior mesenteric vein by CT examination in the efficacy evaluation of neoadjuvant therapy for locally advanced rectal cancer

摘要

摘要: 目的:探讨CT检查测量直肠上静脉和肠系膜下静脉直径变化评估局部进展期直肠癌新辅助治疗效果的应用价值。
方法:采用回顾性描述性研究方法。收集2016年2月至2019年2月重庆医科大学附属第一医院收治的40例行新辅助治疗的局部进展期直肠癌患者的临床病理资料；男28例，女 12例；年龄为(55±12)岁，年龄范围为12～75岁。所有患者在新辅助治疗后按照全直肠系膜切除原则行直肠癌根治术治疗。观察指标： (1)MRI检查情况。(2)CT检查情况。（3）手术情况。(4)随访情况。采用门诊方式进行随访，了解患者术后并发症发生情况。随访时间截至2019年6月。正态分布的计量资料以Mean±SD表示，组内比较采用配对样本t检验。计数资料以绝对数或百分比表示。
结果: (1)MRI检查结果：40例患者中，直肠癌侵犯壁外血管形成癌栓(EMVI)阳性22例，EMVI阴性18例。(2)CT检查结果： 40例患者新辅助治疗前、后，直肠上静脉直径分别为(3.9±0.9)mm、(3.0±0.6)mm，两者比较，差异有统计学意义 (t=5.75，P<0.05)。30例对新辅助治疗有反应患者，新辅助治疗前、后，直肠上静脉直径分别为(4.1±1.0)mm、(3.4±0.7)mm，两者比较，差异有统计学意义(t=6.20，P<0.05)。10例对新辅助治疗无反应患者，新辅助治疗前、后，直肠上静脉直径分别为(3.6±0.6)mm、(3.5±0.8)mm，两者比较，差异无统计学意义 (t=1.13，P>0.05)。新辅助治疗前22例EMVI阳性患者和18例EMVI阴性患者直肠上静脉直径分别为(4.2±0.8)mm、(3.7±0.8)mm，两者比较，差异有统计学意义(t=2.45，P<0.05)。40例患者新辅助治疗前、后，肠系膜下静脉直径分别为(5.1±0.9)mm、(4.2±0.9)mm，两者比较，差异有统计学意义(t=4.16，P<0.05)。30例对新辅助治疗有反应患者，新辅助治疗前、后，肠系膜下静脉直径分别为(5.1±0.9)mm、(4.6±0.8)mm，两者比较，差异有统计学意义(t=0.76，P<0.05)。10例对新辅助治疗无反应患者，新辅助治疗前、后，肠系膜下静脉直径分别为(5.0±0.9)mm、(4.8±1.0)mm，两者比较，差异无统计学意义(t=0.76，P>0.05)。新辅助治疗前22例EMVI阳性患者和18例EMVI阴性患者肠系膜下静脉直径分别为(4.8± 0.9)mm、(4.6±0.8)mm，两者比较，差异无统计学意义(t=2.45，P>0.05)。(3)手术情况： 40例患者均行直肠癌根治术，其中4例同时性肝转移患者同期行肝转移灶切除术。(4)随访情况：40例患者术后均获得随访，随访时间为3.0～6.0个月，中位随访时间为4.5个月。40例患者中，1例术后出现会阴部切口感染，予以换药后好转出院；1例术后第5天出现吻合口漏，保守治疗好转出院；2例术后1个月出现粘连性肠梗阻，其中1例手术治疗后好转，1例保守治疗后好转；其余36例患者均顺利出院，门诊随访无明显异常。
结论:CT检查测量局部进展期直肠癌患者的直肠上静脉和肠系膜下静脉直径在新辅助治疗后会显著减小。两者可作为评估直肠癌新辅助治疗效果的潜在指标，并且直肠上静脉评估价值可能更高。

Abstract: Objective:To investigate the application value of diameter change of superior rectal vein (SRV) and inferior mesenteric vein (IMV) by CT examination in the efficacy evaluation of neoadjuvant therapy for locally advanced rectal cancer.
Methods:The retrospective descriptive study was conducted. The clinicopathological data of 40 patients with locally advanced rectal carcer who underwent neoadjuvant therapy in the First Affiliated Hospital of Chongqing Medical University were collected. There were 28 males and 12 females, aged from 12 to 75 years, with the age of (55±12)years. All patients underwent radical resection of rectal cancer according to the principle of total mesorectal resection after neoadjuvant therapy. Observation indicators: (1) MRI examination; (2) CT examination; (3) surgical situations; (4) followup. Follow-up was performed using outpatient examination to detect postoperative complications up to June 2019. The measurement data with normal distribution were represented as Mean±SD, and paired sample t test was used for intragroup comparison. Count data were described as absolute numbers or percentages.
Results:(1) MRI examination: there were 22 patients with positive extramural vascular invasion (EMVI) and 18 with negative EMVI. (2) CT examination: the diameter of SRV was (3.9±0.9) mm and (3.0±0.6)mm before and after neoadjuvant therapy, showing a significant difference (t=5.75, P<0.05). Subgroup analysis: for the 30 patients with response to neoadjuvant therapy, the diameter of SRV changed significantly after neoadjuvant therapy ［(4.1±1.0)mm vs. (3.4±0.7)mm, t=6.20, P<0.05］; for the 10 patients without response to neoadjuvant therapy, the diameter of SRV showed no significant difference after neoadjuvant treatment ［(3.6±0.6)mm vs. (3.5±0.8)mm, t=1.13, P>0.05］. The diameter of SRV was (4.2±0.8)mm in 22 patients with EMVI and (3.7±0.8)mm in 18 patients with negative EMVI, showing a significant difference between the two groups (t=2.45, P<0.05). The diameter of IMV was (5.1±0.9)mm and (4.2± 0.9)mm before and after neoadjuvant therapy, showing a significant difference (t=4.16, P<0.05). Subgroup analysis: for the 30 patients with response to neoadjuvant therapy, the diameter of IMV changed significantly after neoadjuvant treatment ［(5.1±0.9)mm vs (4.6±0.8)mm, t=0.76, P<0.05］; for the 10 patients without response to neoadjuvant therapy, the diameter of SRV showed no significant difference after neoadjuvant treatment ［(5.0±0.9)mm vs (4.8±1.0)mm, t=0.76, P>0.05］. The diameter of IMV was (4.8±0.9)mm in 22 patients with EMVI and (4.6±0.8)mm in 18 patients with negative EMVI, showing no significant difference between the two groups (t=2.45, P>0.05). (3)Surgical situations:40 patients underwent radical resection of rectal cancer,including 4 with synchronous liver metastases undergoing resection of metastases.(4) Follow-up: 40 patients were followed up for 3.0-6.0 months, with a median followup time of 4.5 months. One of 40 patients with perineal incision infection was improved and discharged after dressing change, 1 with anastomotic leakage on the 5th day after operation was improved and discharged after conservative treatment, 1 of 2 with adhesive intestinal obstruction was improved after surgery and 1 was improved after conservative treatment, other 36 patients were discharged and no obvious abnormality occured during the followup.
Conclusions:The diameters of SRV and IMV in patients with locally advanced rectal cancer can be significantly decreased significantly after neoadjuvant therapy. The diameters of SRV and IMV can be used as potential indices to evaluate the effects of neoadjuvant therapy for rectal cancer, and the SRV had a higher evaluation value.

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