多层螺旋CT在结肠直肠肿瘤诊断中的临床应用研究  

The clinical application of multi-spiral computed tomography in the diagnosis of colorectal tumors

作　　者：曹晖[1] 刘申[1] 金鑫[1] 刘骅[1] 王少华[1] 庄治国[2] 冯琦[2] 

机构地区：[1]上海交通大学医学院附属仁济医院普外科,上海200127 [2]上海交通大学医学院附属仁济医院放射科,上海200127

出　　处：《外科理论与实践》2010年第2期123-128,共6页Journal of Surgery Concepts & Practice

基　　金：上海市科学技术委员会科研计划项目(054119501)

摘　　要：目的:研究和评价多层螺旋CT(multi-spiral computed tomography,MSCT)在结肠直肠肿瘤诊断中的临床应用和价值。方法:收集仁济医院普外科2004年至2009年接受手术的326例结肠直肠肿瘤病人。①选取其中284例和264例分别进行MSCT结肠定位、定性诊断,并与X线钡剂灌肠及电子肠镜检查的结果进行对比;②取其中75例结肠癌病人同时接受常规放射剂量与低放射剂量结肠MSCT检查,并比较两者在结肠成像上的差别;③运用低放射剂量CT对84例结肠肿瘤病人进行TNM分期,并与其术后病理结果进行对比分析。结果:①在264例同时接受MSCT与钡剂灌肠的结肠直肠肿瘤病人中,MSCT的定位准确率为96.2%(254/264),钡剂灌肠的定位准确率为89.4%(236/264);284例同时接受MSCT与电子肠镜检查的结肠直肠肿瘤病人的MSCT的定位准确率为94.0%(267/284),而其电子肠镜的定位准确率达90.1%(256/284)。可见,MSCT对结肠直肠肿瘤的定位准确率高于钡剂灌肠和电子肠镜。在结肠直肠肿瘤定性诊断中,结肠直肠MSCT的诊断率(87.5%)高于钡剂灌肠(85.2%),而低于电子肠镜检查(95.4%),但差异尚无统计学意义。②对75例同时接受常规剂量结肠CT和低剂量CT检查病人的的成像质量进行对比,结果显示两者无明显差异(P>0.05)。③低剂量结肠CT在结肠术前TNM分期诊断准确率为79.8%,与术后病理比较,并无统计学差异(P>0.05)。④术后对32例结肠直肠肿瘤病人随访2年,MSCT发现其中6例出现肿瘤复发和转移。结论:MSCT在结肠直肠肿瘤的术前定位、定性及术前分期诊断中具有较高的准确率,并在术后随访中发挥重要作用。低剂量结肠CT的放射剂量大幅降低,安全性提高,结合仿真结肠镜和展平显示技术能基本满足结肠直肠病变的筛查和分期要求。Objective To investigate the clinical value of multi-spiral computed tomography（MSCT） in the diagnosis and treatment of colorectal cancers.Methods Three hundred and twenty-six patients with colorectal tumor admitted to the Ren Ji hospital from Jun.2004 to Jan.2009 were enrolled in this study.① 264 patients with colon cancer were selected to undergo MSCT,as compared with the barium enema and colonoscopy,to discern localization and qualitative diagnosis.②Seventy-five patients with colon cancer underwent low-dose MSCT as well as the standard dose MSCT;the image quality offered by low-dose MSCT was compared to that offered by standard dose MSCT.③ In 84 patients,low-dose MSCT was used to discern the TNM staging of colonic cancer,as compared with that offered by histologic evaluation.We also compared the non-bowel preparing MSCT with the standard MSCT in diagnosing the inflammatory bowel disease.Results ① Among the 264 patients having both MSCT and barium enema,the localization accuracy of MSCT was（254/264,96.2%）,and that of barium enema was（236/264,89.4%）,respectively.Among the 284 patients who had both MSCT and colonoscopy,the localization accuracy of the colonoscopy was（256/284,90.1%） and MSCT was（267/284,94.0%）,respectively.For the accuracy in localization diagnosis of the colonic cancers,MSCT was better than the barium enema and colonoscopy.As for the qualitative diagnosis of colorectal tumors,the accuracy of MSCT（87.5%） was higher than that of the barium enema（85.2%）,but was lower than the colonoscopy（95.4%）.② There was no significant difference in image quality between the low-dose MSCT subgroup and the standard dose MSCT subgroup among the 75 patients studied.③The accuracy of low-dose MSCT for colonic cancer TMN staging pre-operatively was 79.8%,and the difference between the low-dose MSCT and the pathologic diagnosis was not significant.④In addition,32 colorectal patients was followed-up for about 2 years after the operation;by MSCT,6 patients were found to have re

关 键 词：多层螺旋CT 低放射剂量 TNM分期 结肠直肠肿瘤 

分 类 号：R735.3[医药卫生—肿瘤]