| Objective:The volume of rectum and pelvis is measured by MRI three-dimensional,and then the ratio is obtained.The influence of this value on rectal surgery,including operation time,bleeding volume and complications is analyzed,and its relevant experience and laws are summarized,so as to improve the understanding of clinical workers and scholars,make more effective use of the value of MRI,and provide reference for further clinical research and application.Methods:All patients with rectal cancer confirmed by preoperative colonoscopy pathology in the China-Japan Union Hospital of Jilin University from August 2019 to October2020 were collected.According to the purpose of this study,formulate relevant inclusion criteria and exclusion criteria.58 patients who met the inclusion conditions were selected,including 31 males and 27 females.All patients underwent colonoscopy,abdominal CT and rectal magnetic resonance（MRI）before operation.The pelvic measurement parameters used include:rectal volume,pelvic volume,rectal/pelvic volume ratio,anterior posterior diameter of pelvic inlet,transverse diameter of pelvic inlet,anterior posterior diameter of middle pelvis,transverse diameter of middle pelvis,anterior posterior diameter of pelvic outlet,transverse diameter of pelvic outlet,pelvic height and pelvic depth.The values of pelvic related parameters were measured on MRI frontal plane,side view plane and rear view plane,and the three-dimensional images were synthesized by computer software to calculate the pelvic volume.The measurement process of rectal volume needs to manually map the cross-sectional area of rectum and its mesentery according to the clinical experience of doctors.This step needs to be repeated at each level of pelvic floor,combined with the height of rectum,and finally synthesize three-dimensional images through computer software and calculate its volume.When the rectal and pelvic volumes are obtained,the volume ratio can be obtained together.Through spss22.0 for statistical analysis to evaluate their respective effects on endoscopic rectal surgery.Results:1.General conditions A total of 58 eligible cases of rectal cancer were collected,including 31 males（53.4%）and 27 females（46.6%）.The average age was（62.7±8.8）years;The height is 150-180cm,and the average value is（165.71±8.21）;The body weight was 38-92kg,and the average value was（66.19±12.54）;BMI 14.84-32.05,the average value is（23.99±3.41）.The basic diseases before operation included:multiple colonic polyps（14.9%）,intestinal obstruction（6.8%）,type 2 diabetes（9.5%）,hypertension（20.3%）,coronary heart disease（1.4%）,pneumonia（5.4%）,anemia（13.5%）,and a small number of patients suffering from various basic diseases.The average operation time was（190.67±60.61）minutes.The intraoperative bleeding volume was 50-400ml,and the average bleeding volume was（130.20±55.94）ml.A few patients（20.7%）had complications,mainly including hypoproteinemia（12.1%）,anastomotic fistula（5.2%）and incision infection（3.4%）.2.Basic information and gender comparison of pelvic diameter The P values of height and weight were less than 0.0001,the difference is statistically significant,that is,there are gender differences in height and weight.There was no significant difference in other related parameters except height and weight.There were significant gender differences in the measured diameter lines related to the pelvis.The anterior posterior diameter of the pelvic inlet（P=0.0001）,the transverse diameter of the pelvic inlet（P=0.0006）,the anterior posterior diameter of the middle pelvis（P<0.0001）,the transverse diameter of the middle pelvis（P<0.0001）,the anterior posterior diameter of the pelvic outlet（P=0.0031）and the transverse diameter of the pelvic outlet（P<0.0001）of the male pelvis were significantly smaller than those of the female,The pelvic depth（P<0.0001）was significantly greater than that of women,and the pelvic height（P=0.4773）was equivalent to that of women.3.Sex comparison of rectal volume,pelvic volume and rectal/pelvic volume ratio In terms of gender comparison of pelvic volume parameters,male rectal volume（male:221.62±14.45 cm~3,female:178.56±22.47 cm~3,P<0.0001）and rectal/pelvic volume ratio（male:0.4707±0.0478,female:0.3547±0.0584,P<0.0001）were significantly higher than women,Pelvic volume（male:472.49±17.58 cm~3,female:506.07±17.48 cm~3,P<0.0001）was significantly smaller than that of female.4.Influence of pelvic related volume parameters on operation In terms of surgical bleeding volume,both male and female groups were related to rectal volume（male:P=0.0063,female:P<0.0002）,pelvic volume（male:P=0.0010,female:P=0.0003）and rectal/pelvic volume ratio（male:P=0.0024,female:P=0.0003）;In terms of operation time,both male and female groups were also related to rectal volume（male:P=0.0003,female:P=0.0004）,pelvic volume（male:P=0.0001,female:P=0.0005）and rectal/pelvic volume ratio（male:P=0.0002,female:P=0.0004）.When men and women were combined and analyzed,the results were still consistent with those without grouping,P<0.05,that is,the operation time and bleeding volume are related to rectal volume,pelvic volume and rectal/pelvic volume ratio.After logistic regression analysis,the results showed that the amount of surgical bleeding was correlated with rectal volume（P=0.0403）,pelvic volume（P=0.0137）and rectal/pelvic volume ratio（P=0.0273）;The operation time was correlated with rectal volume（P=0.0001）,pelvic volume（P=0.0001）and rectal/pelvic volume ratio（P=0.0001）.5.Effect of pelvic related volume parameters on postoperative complications The correlation between pelvic volume parameters and postoperative hypoproteinemia,anastomotic leakage and incision infection was analyzed.It was found that there was no significant correlation between hypoproteinemia,anastomotic leakage and incision infection and pelvic volume parameters,P>0.05。Conclusions:1.MRI（magnetic resonance imaging）is feasible and widely used in the measurement of pelvic related parameters;2.There were gender differences in pelvic volume parameters.The pelvic volume of men was smaller than that of women,while the rectal volume and rectal/pelvic volume ratio were significantly larger than that of women;3.The rectal/pelvic volume ratio was positively correlated with rectal operation time and intraoperative bleeding.The rectal/pelvic volume ratio may be a predictor of the difficulty of rectal surgery. |
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