术前评估在中、低位直肠癌外科决策中的应用  

Role of multimodal preoperatively evaluation in surgical decision making for lower and middle rectal cancer

作　　者：宋欢[1] 汪晓东[2] 邓磊[1] 欧阳书睿[1] 方超[1] 吕东昊[1] 吴俊华[3] 时莹瑜[4] 李立[1] 

机构地区：[1]四川大学华西医院临床医学院/MCQ团队,成都610041 [2]四川大学华西医院胃肠外科中心,成都610041 [3]四川大学华西医院影像科,成都610041 [4]四川大学华西医院超声诊断科,成都610041

出　　处：《重庆医学》2010年第12期1499-1502,共4页Chongqing medicine

基　　金：四川省卫生厅科研课题资助项目(080278)

摘　　要：目的探讨多学科协作模式(MDT)下经直肠超声(TRUS)、64排多层螺旋CT(MSCT)和血清淀粉样蛋白A(SAA)多模式术前评估在中、低位直肠癌临床外科决策中的应用价值。方法前瞻性纳入2008年7月至2009年3月本院的中、低位直肠癌患者(肿瘤下缘距齿状线≤10cm),随机均分为MPE组(术前行TRUS、MSCT和SAA联合评估),MSCT+SAA组(术前行MSCT和SAA联合评估)和MSCT组,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218例,MPE组74例,MSCT+SAA组72例,MSCT组72例,3组基线情况一致。MPE组术前T、N、M和TNM分期的准确度分别为94.6%、85.1%、100%和82.4%;MSCT+SAA组的术前T、N、M和TNM分期的准确度分别为77.8%、84.7%、100%和81.9%;MSCT组的术前T、N、M和TNM分期的准确度分别为80.6%、69.4%、100%和70.8%。3组的术前T分期准确度差异有统计学意义(P=0.003,P=0.010),3组的术前N分期准确度差异有统计学意义(P=0.023,P=0.029)。3组手术方案的预测符合率分别为95.9%、88.9%和80.6%,MPE组和MSCT组之间差异有统计学意义(P=0.001)。分析中、低位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=0.002)和肿瘤下缘距齿状线距离(P=0.030)与中、低位直肠癌手术方案的选择相关。结论 MPE可以实现目前最为准确的中、低位直肠癌术前分期准确性,为手术方案预测提供可靠的客观依据。Objective To determine the role of multimodal preoperative evaluation （MPE） of transrectal ultrasound（TRUS）, 64 multi-slice spiral computer tomography （MSCT） and serum amyloid A protein （SAA） in the surgical decision making for the lower and middle rectal cancer by multi-disciplinary team.Methods Prospectively enrolled patients, who were diagnosed definitely as lower and middle rectal cancer （distance of tumor to the dentate line≤10 cm） at West China Hospital of Sichuan University from July 2008 to March 2009, randomly assigned into three groups, MPE group （the preoperative workup consists of TRUS, MSCT and SAA）, MSCT＋SAA group （the preoperative workup consists of MSCT and SAA）, and MSCT group （only MSCT was performed preoperatively）.Then, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively.Furthermore, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathological factors.Results 218 patients with lower and middle rectal cancer were randomly assigned into MPE group （n=74）, MSCT＋SAA group （n=72） and MSCT group （n=72）.The baselines characteristics of two groups were statistically similar.For MPE group the accuracies of preoperative staging T, N, M and TNM were 94.6%, 85.1%, 100% and 82.4%, respectively; For MSCT＋SAA group the corresponding rates were 77.8%, 84.7%, 100% and 81.9%, respectively; For MSCT group the corresponding rates were 80.6%, 69.4%, 100% and 70.8%, respectively The analysis showed statistical difference in the accuracy of preoperative T staging between MPE group and MSCT＋SAA group （P=0.003）, and MSCT group （P=0.010）.The significantly statistical difference of accuracy of preoperative N staging were observed between MSCT group and MPE group （P=0.023）, and MSCT＋SAA group （P=0.029）.There was a statistically significant increasing of the accuracy of prediction

关 键 词：直肠肿瘤 外科手术 螺旋计算机体层摄影术 经直肠超声 血清淀粉样蛋白A 多模式术前评估 

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