天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (9): 935-939.

• 临床研究 • 上一篇    下一篇

个体化经肛提肌外腹会阴联合直肠切除术治疗肛提肌裂孔下方直肠肿瘤对盆底影响的有限元分析

刘嘉，王捷夫△，孔大陆，郑磊，胡冬至，郭建生   

  1. 1. 天津医科大学肿瘤医院；国家肿瘤临床医学研究中心；天津市“肿瘤防治”重点实验室；天津市恶性肿瘤临床医学研究中心
    2. 天津医科大学肿瘤医院
    3. 天津医科大学肿瘤医院结直肠肿瘤科
  • 收稿日期:2017-04-11 修回日期:2017-06-13 出版日期:2017-09-15 发布日期:2017-09-25
  • 通讯作者: 王捷夫 E-mail:jwang05@tmu.edu.cn
  • 基金资助:
    天津市卫计委重点攻关项目;天津医科大学肿瘤医院肿瘤转化医学种子基金

Finite element analysis of the effects of individual extralevator abdominoperineal excision for rectal neoplasms below levator hiatus on pelvic floor

LIU Jia, WANG Jie-fu△, KONG Da-lu, ZHENG Lei, HU Dong-zhi, GUO Jian-sheng   

  • Received:2017-04-11 Revised:2017-06-13 Published:2017-09-15 Online:2017-09-25
  • Contact: Jie-Fu WANG E-mail:jwang05@tmu.edu.cn

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摘要： 摘要：目的 应用有限元分析方法探讨个体化经肛提肌外腹会阴联合直肠切除（ELAPE）术治疗肛提肌裂孔下 方的直肠肿瘤对术后盆底生物力学的影响。方法 利用 MIMICS 10.01、GeoMagic Studio 12 及 ANSYS Workbench 14.0 软件，处理 27 例健康未育女性志愿者的盆底核磁共振数据并建立 3 种盆底有限元模型：正常模型、ELAPE 模型 和个体化 ELAPE 模型，测量 3 种模型在相同载荷作用下非肛提肌组织内的最大应力及正常模型与个体化 ELAPE 模型肛提肌内的最大应力，并观察应力分布。结果 正常模型、ELAPE 模型和个体化 ELAPE 模型的非肛提肌组织 内最大应力分别为（1.963±0.061）MPa、（5.127±0.070）MPa 和（4.703±0.110）MPa，个体化 ELAPE 模型最大应力低于 ELAPE 模型，但高于正常模型（均 P＜0.01）；前两者的高应力区出现在左右两侧与周围结构的连接处，后者的高应力 区出现在左右两侧与周围结构连接处的前部，三者最大应力均出现在左右两侧的最前端。正常模型肛提肌内最大 应力为（0.812±0.042）MPa，高于个体化 ELAPE 模型的（0.719±0.027）MPa（P＜0.01）；前者的高应力区出现在左右两 侧与周围结构连接处的前部，最大应力出现在左右两侧的最前端；后者的高应力区出现在剩余肛提肌与周围结构连 接处的前部，最大应力出现在左右两侧最前端的上部。结论 该个体化 ELAPE 术对于盆底非肛提肌组织内的应力 有降低作用，在一定程度上能够降低术后发生盆底疝的风险。

关键词: 直肠肿瘤, 直肠结肠切除术, 重建性, 骨盆底, 生物力学, 有限元分析, 模型, 生物学

Abstract: Objective To evaluate the effects of individual extralevator abdominalperineal excision(ELAPE) for Rectal Neoplasms below levator hiatus on pelvic floor by finite element analysis. Method MIMICS 10.01, GeoMagic Studio 12 and ANSYS Workbench 14 were used to deal with magnetic resonance data of 27 healthy nulliparous volunteers’ pelvic, and then three types of finite element models were developed: intact models, ELAPE models and individual ELAPE models. Non-levator ani tissue’s maximal stresses of three types of models, and levator ani’s maximal stresses of intact models and individual ELAPE models, and their stress distributions under the same pressure were analyzed and compared. Results In intact models, ELAPE models and individual ELAPE models, non-levator ani tissue’s maximal stresses were respectively (1.963±0.061), (5.127±0.070) and (4.703±0.110) MPa. Those in individual ELAPE models were lower than in ELAPE models, but higher than in intact models(P<0.01). The high-stress zone of intact models and ELAPE models showed at the joints with surrounding structures on both sides; the high-stress zone of individual ELAPE models showed in front of the joints with surrounding structures on both sides; and, the maximal stresses of three types of models showed in front of both sides. In intact models and individual ELAPE models, levator ani’s maximal stresses were respectively （0.812±0.042）and（0.719±0.027）MPa. The latter were lower than the former. The high-stress zone of both showed in front of the joints on both sides. The former maximum stressed showed at ventral ends on both sides, and the latter showed higher than the former on both sides. Conclusion This individual ELAPE is able to decrease the stress of non-levator ani tissue, which suggests that the risk of postoperative pelvic floor hernia is relatively reduced.

Key words: ectal neoplasms, Pelvic Floor, Biomechanics, Finite element analysis