| Objective:To explore the clinical value of enhanced three-dimensional CT of colon for preoperative evaluation of TNM staging of colorectal cancer,to understand the clinical value of shape and variation of mesenteric vessels.To provide reference for the surgical treatment of colorectal cancer.Methods:A total of 44 patients with colorectal cancer who underwent laparoscopic surgery in our hospital from June 2017 to March 2018 were collected.They were divided into two groups.In group I,34 patients underwent enhanced three-dimensional CT of colon examination and fiberoptic colonoscopy before operation.10 patients in group II only underwent fiberoptic colonoscopy before surgery.Comparison of the accuracy of enhanced three-dimensional CT of colon and fiberoptic colonoscopy in the diagnosis of colorectal cancer;Comparison of the consistency of enhanced three-dimensional CT of colon diagnosis of colorectal cancer TNM staging and pathological results.Observation of the effect of enhanced three-dimensional CT on laparoscopic surgery before Operation.Record the typing of Henle and mesenteric vessel relationship.Include:Superior Mesenteric Artery(SMA)and Superior Mesenteric Vein(SMV);Ileocolic Artery(ICA)and Ileocolic Vein(ICV);Ileocolic Artery(ICA)and Superior Mesenteric Vein(SMV);Right Colon Artery(RCA)and Superior Mesenteric Vein(SMV);Whether the Left Colon Artery(LCA)and the Sigmoid Colon Artery(SA)belong to the same genus of inferior mesenteric artery(IMA).Results:1.Distribution of lesions in 44 patients with colorectal cancer:11 cases were located in ileocecal department(25.0%),8 cases were located in colon ascendens(18.2%),6 cases were located in colon transversum(13.6%),9 cases were located in colon descends(20.4%),5 cases were located in colon sigmoideum(11.4%),and 5 cases were located in rectum(11.4%).2.The diagnostic accuracy of enhanced three-dimensional CT of colon for colorectal cancer is 88.2%.The accuracy rate of colonoscopy for colorectal cancer is 97.1%,The difference between them was not statistically significant(P>0.05).3.Kappa consistency test was performed between preoperative imaging and pathological TN staging in group I.The results of T staging were k=0.731,the results of N staging were k=0.727,all with good consistency(P<0.05).Among 34 patients,30 cases were in M0 stage and 4 cases were in Mi stage,all of which were detected by hepatic metastasis.4.The operative time,blood loss and postoperative gastrointestinal recovery time of patients in group I and group II were compared.The group I were less than those in group ?(P<0.05).5.Thirty-four patients in group I had enhanced three-dimensional CT of colon to show the type of Henle and the relationship between mesenteric vessels was consistent with the intraoperative observation.The results showed that:Type of Henle:12 cases of two-branch type with 35.29%,18 cases of three-branch type with 52.94%,3 cases of four-branch type with 8.82%,one case of non-branch type with 2.95%.SMA was located on the ventral side of SMV in 19 cases(55.88%),and located on the dorsal side in 15 cases(44.12%).ICV was located on the ventral side of ICV in 12 cases(35.29%),and located on the dorsal side in 22 cases(64.71%).ICA was located on the ventral side of SMV in 14 cases(41.18%),and located on the dorsal side in 20 cases(58.82%).RCA was located on the ventral side of SMV in 25 cases(73.53%),and located on the dorsal side in 9 cases(26.47%).There were 18 cases(52.94%)with different generic branches of LCA and SA,and 16 cases(47.06%)had the same generic branch.Conclusion;1.The diagnostic rate of enhanced three-dimensional CT of colon in colorectal cancer is similar to that of colonoscopy.It is helpful to evaluate the location of colorectal cancer and TNM staging before operation.2.Preoperative evaluation of variation and location of mesenteric vessels by enhanced three-dimensional CT of colon can shorten the operation time,reduce the amount of intraoperative bleeding and shorten the recovery time of intestinal function. |
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