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To explore surgical approaches and skills about adult anterior sacral tumor. Methods: 10 adult sacral tumor patients during 2009-2011 had been retrospectively analyzed, combined with literature study. Results: All of the cases accepted complete resection, 5 by sacrococcygeal approach, 4 by transabdominal approach, 1 by extra-peritoneal approach. There is no complication like perioperative mortality or abnormal defecation and bleeding. Only one mucinous liposarcoma recurrence has been detected during a 2 - 4 years follow up. Conclusion: tumors below 3th sacral plane especially more than half of which could be reached by digital rectal examination are suitable for the sacrococcygeal approach. Those higher and larger are adapting the abdominal approach. Preoperational preparation and operative skills are also of great importance to obtain satisfactory therapeutic result.
目的：本研究通过测量不同T、N分期直肠癌患者直肠系膜的平均CT衰减值，以寻求直肠癌CT术前T、N分期新的参考指征。方法：纳入2010年9月至2012年9月在四川大学华西医院胃肠外科行手术治疗的直肠中下段腺癌病人123例，术前均采用64排MSCT行全腹部及盆部增强扫描。在每例患者的CT上选取3个癌肿平面，每个平面的直肠系膜上选取6个椭圆形ROI测量CT衰减值，并计算出直肠系膜的平均CT衰减值，然后将不同T、N分期的直肠系膜平均CT衰减值进行相关分析及对比。结果：直肠系膜的平均CT衰减值与直肠癌T分期正相关(rs = 0.439，P < 0.001)，但是除T4期高于T1-3期并有统计学意义外(P均 < 0.05)，T1、T2、T3期两两间的差异没有统计学意义(P均 > 0.05)；直肠系膜的平均CT衰减值与N分期没有相关关系(rs = 0.030, P = 0.740)，N0、N1、N2期两两间的差异没有统计学意义(P均 > 0.05)。结论：直肠系膜CT衰减值可为鉴别中下段直肠癌是否侵出直肠系膜提供重要的辅助指标。
To find a new method for preoperative CT staging in rectal cancer by measuring the mean CT value of mesorectum in patients with different T, N stages. Methods: 123 patients who were diagnosed with middle or lower rectal adenocarcinoma and accepted surgery during September 2010 to September 2012 in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University were enrolled. Contrast-enhanced 64-slice spiral CT examination of the abdomen and pelvis was performed before operation. In every patient, 3 planes of tumor were selected on CT. On each plane, 6 elliptical ROIs were selected within the mesorectum and the CT value of each ROI was measured. Then the mean CT value of mesorectum was calculated. The correlation analysis between the mean CT value and T, N stage was conducted and the mean CT value of mesorectum of different T, N stages was compared. Results: The mean CT value of mesorectum and the T stage of rectal cancer were positively correlated (rs = 0.439, P < 0.001). The mean CT value of T4 was significantly higher than T1-3(all P < 0.05), but there was no statistical difference between each pair of T1, T2 and T3 (all P > 0.05). There was no statistical correlation between the mean CT value and N stage of rectal cancer (rs = 0.030, P = 0.740). The mean CT value of mesorectum had no statistically difference between each pair of N0, N1, N2 (all P > 0.05). Conclusion: The CT value of mesorectum can be a useful index to help identify whether the tumor has invaded out of the mesorectum or not in the middle and lower rectal cancer.