Lorenzon Laura, Bini Fabiano, Landolfi Federica, Quinzi Serena, Balducci Genoveffa, Marinozzi Franco, Biondi Alberto, Persiani Roberto, D'Ugo Domenico, Tirelli Flavio, Iannicelli Elsa
General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy.
Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, 00185, Rome, RM, Italy.
Int J Colorectal Dis. 2021 May;36(5):977-986. doi: 10.1007/s00384-020-03802-9. Epub 2020 Nov 23.
Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution.
A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx's tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses.
Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape.
Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.
男性、高体重指数、骨盆狭窄和直肠系膜肥厚被认为是结直肠手术中与困难盆腔解剖相关的临床变量。本文旨在比较女性和男性患者的骨盆生物测量数据，并探讨骨盆测量分割如何有助于可视化直肠系膜分布。
使用三维软件对60岁连续接受选择性腹部CT扫描患者的DICOM数据进行分割。测量以下指标：骨盆入口、出口和深度；耻骨结节高度；从骶岬到尾骨和S3/S4的距离；从S3/S4到尾骨尖的距离；坐骨棘间距；骨盆倾斜度；偏移角；骨盆入口角；入口/骶岬/尾骨之间的角度；骶岬/尾骨/骨盆出口之间的角度；S3角；以及骨盆入口与骨盆深度之比。使用统计分析比较男性和女性的测量结果。
分析了200例患者（男/女1:1）。在21项骨盆测量中，19项记录了两组之间显著的平均差异。具体而言，女性患者的骨盆入口和出口明显更宽，但骨盆深度、骶岬/骶骨/尾骨距离较短，与男性相比，入口/深度比增加（p<0.0001）。唯一的例外是真结合径（p = 0.06）和S3角（p = 0.17）。三维分割根据骨盆形状提供了直肠系膜分布的视角。
男性和女性骨盆结构存在显著差异。外科医生在处理直肠时必须了解骨盆形状。
