微探头联合环扫内镜超声对直肠癌术前分期的价值  

Endoscopic ultrasonography with combination of miniature probe and radial scanning in preoperative staging for rectal cancer

作　　者：夏璐[1] 戴欣[1] 刘慧黎[1] 林谋斌[2] 尹路[2] 诸琦[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院消化内科,200025 [2]上海交通大学医学院附属瑞金医院普外科,200025

出　　处：《中华消化内镜杂志》2009年第4期175-179,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价微探头超声联合环扫内镜超声检查对直肠癌术前分期的特异性、敏感性和准确性以及判断其对直肠癌治疗方案选择的价值。方法对2007年8月-2008年8月60例术前直肠癌患者行微探头和环扫超声内镜联合探查。参照TNM分期标准进行分期诊断，并与MRI、手术后组织病理学结果对比，总结EUS分期对治疗方案选择的参考价值。结果在60例直肠癌患者中，EUS分期T1期4例，T2期18例，T3期30例，T4期8例，存在7例分期过度和4例分期不足；MRI分期T1期1例，T2期18例，T3期30例，T4期10例，存在14例分期过度和3例分期不足。微探头超声内镜结合环扫型超声内镜对直肠癌T分期诊断综合准确率为81．67％（49／60），N分期的准确率为78．33％，敏感性和特异性为71．43％和91．03％；MRI对直肠癌T分期准确率为71．67％（43／60），周围淋巴结转移诊断的准确率为83．33％，敏感性和特异性为85．71％和86．96％。结论微探头联合环扫内镜超声检查是一有效估计直肠癌肠壁浸润深度并对其进行TN分期的方法，且操作简便、痛苦小、诊断准确率较高。Objective To evaluate the specificity, sensitivity and accuracy of miniature probe combined with radial scanning endoscopic uhrasonography （EUS） in preoperative TN staging of rectal cancer, and to assess its value in the choice of therapeutic strategy. Methods A total of 60 patients with rectal cancer received EUS assessment before surgery. Diagnosis was made according to TNM standard and compared with those of MRI and postoperative pathological examination. The reference value of EUS for therapy selection was studied. Results According to EUS staging, there were 4 cases of T1, 18 T2, 30 T3 and 8 T4, among which 7 cases were over-staged and 4 others were under-staged. MRI staging showed 1 case of T1, 18 T2, 30 T3 and 10 T4, among which 14 were over-staged and 3 others were under-staged. The total accuracy of EUS in T staging and N staging was 81.67% （49/60） and 78.33%, respectively, with the sensitivity and specificity at 71.43% and 91.03%, respectively. Accuracy of MRI for T staging and N staging were 71.67% （43/60） and 83.33%, respectively, with the sensitivity and specificity as 85.71% and 86. 96%. Conclusion EUS with combination of miniature probe and radial scanning is effective in preoperative TN staging of rectal cancer with easy manipulation and less pain.

关 键 词：腔内超声检查 结直肠肿瘤 肿瘤分期 磁共振成像 

分 类 号：R735[医药卫生—肿瘤] R44[医药卫生—临床医学]