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目的术前通过CT影像识别Toldt’s间隙,为腹腔镜结直肠癌手术寻找正确的外科平面,从而制订具有前瞻性的个性化术式。方法通过对南方医科大学附属顺德第一人民医院2010年1月~2012年6月246例腹腔镜结直肠癌手术患者的术前CT影像及术中镜下所见对照观察,确认Toldt’s间隙的位置、沟通和毗邻关系。结果术前CT影像观察到:升降结肠系膜后叶与肾前筋膜融合成的线影即为Toldt’s线。结直肠癌术前CT所显示的Toldt’s筋膜间隙与术中所见具有较好的一致性(Kappa值为0.718)。腹腔镜结直肠癌手术时沿此线切开,以肾前筋膜为参照面,即可建立正确的外科平面。结论①术前CT影像可指导术中构建正确的Toldt’s间隙外科平面,保持肾前筋膜的完整性;②CT可提示肿瘤是否侵犯Toldt’s间隙平面,对于制订个性化术式和预后评估具有前瞻性意义。
Objective To identify the Toldt’s gap through CT images before surgery and find the correct surgical plane for laparoscopic colorectal cancer surgery so as to formulate a prospective and personalized surgical procedure. Methods The CT images of 246 patients with laparoscopic colorectal cancer surgery from January 2010 to June 2012 in Shunde First People’s Hospital Affiliated to Southern Medical University were observed and compared with those observed under the microscope. The location of Toldt’s gap , Communication and proximity. Results preoperative CT images observed: ascending and descending colon mesenteric and anterior fascia fusion line shadow is the Toldt’s line. Colorectal cancer preoperative CT showed Toldt’s fascia gap and intraoperative findings have a good agreement (Kappa value of 0.718). Laparoscopic colorectal surgery along this line incision to the prerenal fascia as the reference surface, you can establish the correct surgical plane. Conclusion ① Preoperative CT imaging can guide the construction of correct Toldt’s interstitial surgery plane and maintain the integrity of prerenal fascia. ②CT can indicate whether the tumor infiltrates the Toldt’s interstitial plane, which is prospective for the development of personalized surgical procedures and prognostic evaluation .