目的

探讨结直肠癌患者术前行CT 血管造影（CTA）三维重建对手术的临床指导价值。

方法

全面检索PubMed、Embase、万方数据库和中国知网数据库从建库至2024 年12 月1 日的文献，筛选关于术前行CTA 并行血管三维重建是否可以提高结直肠癌患者腹腔手术的安全性以及是否具有临床应用价值的文献。由两名评价员独立提取术中出血量、淋巴结清扫数、术后腹腔引流量、肛门排气时间、手术时间、住院时间、术后肠梗阻、吻合口感染及吻合口瘘等结局指标，根据异质性不同采用随机效应模型或固定效应模型进行分析，采用标准化均数差（SMD）、比值比（OR）及其95%置信区间（CI）作为汇总统计量进行荟萃分析，随后进行偏倚分析及敏感性分析。

结果

共纳入22 篇文献1 845 例患者。荟萃分析结果显示，观察组的手术时间、住院时间、术中出血量、术后肛门排气时间、术后腹腔引流量明显少于对照组（P＜0.01）。观察组术中淋巴结清扫数明显多于对照组，并且术后肠梗阻、吻合口感染、吻合口瘘的发生率均明显低于对照组（P＜0.05）。

结论

通过术前CTA 三维重建明确肠系膜血管解剖结构、肿瘤位置，有助于指导结直肠癌手术方案的制定，有利于提高手术的安全性，对结直肠癌手术的开展具有临床指导价值。

Objective

To explore the clinical guidance value of preoperative CT angiography （CTA）combined with three-dimensional reconstruction for colorectal cancer patients.

Methods

A comprehensive search of the literature in PubMed， Embase， Wanfang Database， and China National Knowledge Infrastructure （CNKI） databases up to December 1， 2024 was conducted to identify studies on whether preoperative CTA and three-dimensional vascular reconstruction improving the safety of abdominal surgery in colorectal cancer patients and its clinical application values.Two reviewers independently extracted outcome indicators such as intraoperative blood loss， the number of lymph nodes removed， abdominal drainage volume， time to first flatus， operation time， hospital stay， postoperative intestinal obstruction，anastomotic infection， and anastomotic leakage.Depending on the heterogeneity， a random-effects model or a fixed-effects model was used for analysis.Standardized mean difference （SMD）， odds ratio （OR）， and their 95% confidence interval （CI） were used as summary statistics for Meta-analysis.Subsequently， bias analysis and sensitivity analysis were performed.

Results

A total of 1 845 patients in 22 articles were included in this study.The Meta-analysis results showed that the operation time， hospital stay， intraoperative blood loss，time to first flatus， and postoperative abdominal drainage volume in the observation group were less than those in the control group， with statistically significant differences （P＜0.01）.The number of lymph nodes removed during surgery in the observation group was significantly more than that in the control group， and the incidence of postoperative intestinal obstruction， anastomotic infection， and anastomotic fistula were also significantly lower in the observation group （P＜0.05）.

Conclusion

Preoperative CTA combined with threedimensional reconstruction can clearly delineate the anatomy of the mesenteric vessels and the location of the tumor， which helps in formulating the surgical plan for colorectal cancer and improves the safety of the surgery， thus having clinical guidance value for the conduct of the operation.