直肠癌全直肠系膜切除术术前影像学评估  

Evaluation of Preoperative Imaging in Total Mesorectal Excision for Rectal Cancer

作　　者：王樱花[1] 黄晖[2] 徐香玖[3] 黄刚[3] 马强华[4] 任晓苏[3] 边军[3] 王亚群[3] 

机构地区：[1]兰州大学临床医学院,甘肃兰州730000 [2]江西省上高县人民医院放射科 [3]甘肃省人民医院影像科 [4]兰州军区总医院影像科

出　　处：《实用放射学杂志》2008年第4期487-489,共3页Journal of Practical Radiology

摘　　要：目的行全直肠系膜切除术(TME)探讨影像学对直肠癌病例进行术前评估的价值。方法术前活检病理证实直肠癌63例,进行CT、MR平扫及增强检查(其中CT35例,MR28例)。分析直肠系膜筋膜受累情况、筋膜外淋巴结转移及病灶与肛缘间的曲线距离,结果与术后病理相对照。结果对直肠系膜筋膜受累情况的判断中有2例CT高估,1例MR高估,2组间差异无统计学意义。MR矢状位能清晰显示所有病例的肛缘及肿瘤下缘之间的曲线距离。63例中有37例发现系膜内肿大淋巴结,其中19例病理结果无转移均为反应性增生。16例系膜筋膜外发现肿大淋巴结,其中12例病理结果为转移,4例为反应性增生。结论MSCT及高分辨力MRI对直肠癌患者拟行TME者的术前评估具有重要价值。Objective To study the value of multi - slice spiral CTI MSCTI and high - resolution MR in evaluating the feasibility of total mesoreetal exeision （TME） for rectal cancer before operation. Methods Sixty - three cases biopsy - proven rectal cancer underwent MSCT and high -resolution MR examination,including CT in 35 and MR in 28. The involvement of mesoreetal fascia,lymph nodes extra - fascia and the curve distance between the lesions and the anal margin were observed and compared with that of operation and pathology. Re- suits In evaluating the involvement of mesoreetal fascia,two patients were oversteped by CT and one patient by MRI,and there was no sig- nificantly statistic difference between CT and MRI. The curve distance between lesions and anal margis could be measured accurately on sagittal section of MR images in all cases. Sixteen patients had been found having metastatic lymph nodes at extra -mesoreetal fascia, twelve of them were biopsy - proven. Thirty - seven patients had been found having metastatic lymph nodes at intra - mesoreetal fascia, but 4 of them were inflammatory biopsy - proven. Conclusion MSCT and high - resolution MR are of significant values in evaluating the feasibility of TME in the patients with rectal carcinoma.

关 键 词：直肠癌 直肠系膜 体层摄影术 X线计算机 磁共振成像 

分 类 号：R735.37[医药卫生—肿瘤] R814.42[医药卫生—临床医学]