多层螺旋CT联合不同炎性反应指标对直肠癌外科决策的随机对照研究  

Randomized Controlled Trial of Combining Multi-Slice Spiral Computed Tomography with Inflammatory Biomarkers on Rectal Cancer Surgical Decision Making

作　　者：吕东昊[1] 高强[1] 汪晓东[2] 邓磊[1] 欧阳书睿[1] 方超[1] 李峥艳[3] 李立[2] 

机构地区：[1]四川大学华西临床医学院/华西医院,成都610041 [2]四川大学华西医院肛肠外科,成都610041 [3]四川大学华西医院放射科,成都610041

出　　处：《中国普外基础与临床杂志》2009年第10期851-855,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生厅科研课题(项目编号:080278)~~

摘　　要：目的探讨多学科协作模式下血清淀粉样蛋白A（SAA）或C反应蛋白（CRP）与64排多层螺旋CT（MSCT）联合评估对于直肠癌手术方式选择的影响和意义。方法前瞻性纳入2009年2~8月期间四川大学华西医院肛肠外科住院的直肠癌患者,随机分为MSCT＋SAA组（术前行MSCT和SAA联合评估）和MSCT＋CRP组（术前行MSCT和CRP联合评估）,将术前分期和预测手术方案分别与术后病理分期和实际手术方案比较,并分析手术方案选择与临床病理因素的关系。结果本研究实际纳入病例165例,MSCT＋SAA组83例,MSCT＋CRP组82例,2组基线情况一致（P〉0.05）。MSCT＋SAA组的术前T、N、M和TNM分期的准确度分别为74.7%、68.7%、100%和66.3%;MSCT＋CRP组的术前T、N、M和TNM分期的准确度分别为72.0%、86.6%、100%和81.7%。MSCT＋CRP组术前N分期和TNM分期准确度均高于MSCT＋SAA组（P〈0.05）。2组手术方案的预测符合率分别为90.4%及95.1%,差异无统计学意义（P〉0.05）。分析直肠癌手术方案的选择与多种临床病理因素的关系发现,pT分期（P〈0.001）、pN分期（P〈0.001）、pTNM分期（P〈0.001）、术前血清SAA水平（P=0.010）、术前血清CRP水平（P=0.042）和肿瘤下缘距齿状线距离（P=0.011）与直肠癌手术方案的选择相关。结论MSCT联合CRP可以提高直肠癌术前分期和手术方案预测的准确度,其临床价值可能优于MSCT联合SAA。Objective To determine the influence and significance of combinative assessment of 64 multi-slice spiral computed tomography（MSCT） with serum amyloid A protein（SAA） or C-reactive protein（CRP） on the selection of operative procedures of rectal cancer under the multi-disciplinary team.Methods Prospectively enrolled patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to August 2009 were randomly assigned into two groups.In one group named MSCT＋SAA group,both 64 MSCT and SAA combinative assessment were made for the preoperative evaluation.In another group named MSCT＋CRP group,both MSCT and CRP combinative assessment were made for preoperative evaluation.Furthermore,the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures,respectively,and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed.Results All 165 patients were randomly assigned into MSCT＋SAA group（n=83） and MSCT＋CRP group（n=82）.The baseline characteristics of two groups were statistically similar（P0.05）.For MSCT＋SAA group,the accuracies of preoperative staging T,N,M and TNM were 74.7%,68.7%,100% and 66.3%,respectively.For MSCT＋CRP group,the accuracies of preoperative staging T,N,M and TNM were 72.0%,86.6%,100% and 81.7%,respectively.There were statistically significant differences in the accuracies of N staging and TNM staging between two groups（P0.05）.However,there was no statistically significant difference of the accuracy of prediction to operative procedures between two groups（90.4% vs.95.1%,P0.05）.The pathological T staging（P0.001）,N staging（P0.001）,TNM staging（P0.001）,preoperative serum level of SAA（P=0.010）,serum level of CRP（P=0.042）,and distance of tumor to the dentate line（P=0.011） were associated with the operative procedures.Conclusion Combinative assessment of MSCT＋CRP could improve the

关 键 词：直肠肿瘤 手术 螺旋计算机体层摄影术 血清淀粉样蛋白A C反应蛋白 术前评估 多学科协作 

分 类 号：R735.37[医药卫生—肿瘤]