环扫型经直肠腔内超声检查在直肠癌术前分期诊断中的应用价值  

Clinical value of radial endorectal ultrasound in the assessment of preoperative staging of rectal carcinoma

作　　者：朱江[1] 黄品同[1] 张旭[1] 刘春媚[1] 刘学明[1] 丁克峰[2] 李百周[3] 蔡善荣[4] 郑树[4] 

机构地区：[1]浙江大学医学院附属第二医院超声科,杭州310009 [2]浙江大学医学院附属第二医院肿瘤外科,杭州310009 [3]浙江大学医学院附属第二医院病理科,杭州310009 [4]浙江大学医学院附属第二医院肿瘤研究所,杭州310009

出　　处：《中华肿瘤杂志》2013年第2期148-153,共6页Chinese Journal of Oncology

摘　　要：目的探讨环扫型经直肠腔内超声（ERUS）检查在直肠癌术前分期诊断中的应用价值。方法选择2010年2月至2011年9月在浙江大学第二附属医院肿瘤外科接受手术治疗的110例直肠癌患者，使用超声诊断仪和经直肠腔内环扫探头进行ERUS检查，观察直肠壁的层次及直肠肿块的大小、形态、回声、位置、范围、血流情况、肠壁浸润深度、附近组织受累情况和邻近淋巴结转移情况，进行术前TNM分期，并与术后病理结果对照。结果110例直肠癌中，ERUS诊断uT1期30例，uT2期23例，uT3期47例，uT4期10例。ERUS对直肠癌T分期诊断的总准确率为91．4％，对T1期、他期、T3期和rr4期诊断的准确率分别为92．7％、88．2％、88．2％和96．4％；对T1期、12期、113期和T4期诊断的敏感性分别为92．3％、72．7％、85．4％和71．4％；对T1期、T2期、T3期和T4期诊断的特异性分别为92．9％、92．0％、90．3％和100．0％，与病理T分期的一致性较好（Kappa=0．75，P〈0．001）。ERUS诊断uN0期79例，uN1—2期31例。ERUS对直肠癌N分期诊断的总准确率为85．5％，对N0期和N1—2期诊断的准确率均为85．5％；对N分期诊断的敏感性、特异性、阳性预测值和阴性预测值分别为74．2％、89．9％、74．2％和89．9％，与病理N分期的一致性较好（Kappa=0．64，P〈0．01）。结论环扫型ERUS对直肠癌浸润深度、范围以及肠周淋巴结转移的诊断具有较高的准确性，且操作简便、患者痛苦小，是直肠癌术前分期诊断的有效检查方法。Objective To evaluate the clinical value of radial endorectal ultrasound（ERUS） in the assessment of preoperative staging of rectal carcinoma. Methods One hundred and ten patients with rectal cancer underwent preoperative endorectal ultrasound （ERUS） examination in our hospital from February 2010 to September 2011. ERUS was performed using a Hitachi 900, Hitachi HI Vision Preirus US scanner, with a 5-10 MHz rigid rotating radial transducer and a focal length of 2-5 cm. The size, shape, echo pattern, infiltration depth, degree of circumferential involvement, extra-rectal invasion of the lesions and lymph node involvement were observed. The results of ERUS staging were compared with histopathological findings of the surgical specimens. Results The accuracy of ERUS for T staging was 91.4%. The accuracy of ERUS in diagnosing stage T1, T2, T3, T4 cancers was 92.7% ,88.2% ,88.2% and 96.4%, respectively. The sensitivity of ERUS in diagnosing stage T1, T2, T3, T4 cancers was 92.3% ,72. 7% ,85.4% and 71.4%, respectively. The specificity of ERUS in diagnosing stage T1, ＂1＂2, T3, 3＂4 cancer was 92.9%, 92.0% , 90.3% and 100.0%, respectively. Comparing the consistency of preoperative T-staging and postoperative pathological results, the Kappa value was 0.75, with a considerable consistency. The sensitivity, specificity, and accuracy of ERUS in the assessment of lymph node metastasis were 74. 2%, 89. 9% and 85.5%, respectively. Comparing the consistency of preoperative N-staging and postoperative pathological results, the Kappa value was 0.64, with a considerable consistency. Conclusions ERUS is a practical and accurate tool in assessment of preoperative staging of rectal tumors in regard to tumor invasion depth （T） and regional lymph node status （N）, with advantages of simple operation, less pain, and high accuracy.

关 键 词：直肠肿瘤 腔内超声检查 肿瘤分期 

分 类 号：R735.37[医药卫生—肿瘤]