Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo,Japan.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa040.
Mobilization of the splenic flexure can be a challenging surgical step in colorectal surgery. This study aimed to classify the splenic flexure based on the three-dimensional (3D) coordinates of the splenic hilum and left renal hilum. This classification was used to compare splenic flexure mobilization during colorectal resection.
CT images of patients with colorectal cancer treated between April 2018 and December 2019 were analysed retrospectively. 3D mutual positioning of the splenic flexure from the ligament of Treitz to the splenic hilum or the left renal hilum was used to classify patients into three groups using cluster analysis. The difference in the procedure time between groups was also analysed in a subset of patients undergoing laparoscopic colectomy with complete splenic flexure mobilization.
Of 515 patients reviewed, 319 with colorectal cancers were included in the study and categorized based on the 3D coordinates of the splenic hilum and left renal hilum as caudal (100 patients), cranial (118) and lateral (101) positions. Male sex (P < 0.001), older age (P = 0.004) and increased bodyweight (P = 0.043) were independent characteristics of the lateral group in multiple logistic regression analysis. Thirty-four patients underwent complete splenic flexure mobilization during the study period; this took significantly longer (mean 78.7 min) in the lateral group than in the caudal and cranial groups (41.8 and 43.2 min respectively; P = 0.006).
Locating the splenic flexure using 3D coordinates could be helpful in predicting a longer duration for mobilization of the splenic flexure.
脾曲的游离在结直肠手术中是一个具有挑战性的外科步骤。本研究旨在基于脾门和左肾门的三维（3D）坐标对脾曲进行分类。该分类用于比较结直肠切除术中脾曲游离的情况。
回顾性分析了 2018 年 4 月至 2019 年 12 月期间接受治疗的结直肠癌患者的 CT 图像。使用 3D 互定位技术，从Treitz 韧带到脾门或左肾门对脾曲进行分析，使用聚类分析将患者分为三组。在一组接受完全脾曲游离的腹腔镜结肠切除术的患者中，还分析了各组之间手术时间的差异。
在 515 例患者中，319 例结直肠癌患者被纳入本研究，并根据脾门和左肾门的 3D 坐标分为尾侧（100 例）、头侧（118 例）和外侧（101 例）三组。多因素逻辑回归分析显示，男性（P<0.001）、年龄较大（P=0.004）和体重增加（P=0.043）是外侧组的独立特征。在研究期间，34 例患者接受了完全脾曲游离，外侧组的手术时间明显更长（平均 78.7 分钟），明显长于尾侧组（41.8 分钟）和头侧组（43.2 分钟；P=0.006）。
使用 3D 坐标定位脾曲可能有助于预测脾曲游离的持续时间。
