直肠腔内超声对直肠癌术前分期准确性的研究  

Accuracy of endorectal ultrasonography in preoperative staging of rectal cancer

作　　者：刘作良[1] 梁小波[2] 马峻杰[2] 姜慧员[2] 

机构地区：[1]川北医学院肝胆胰肠疾病研究所,四川省南充市637000 [2]山西省肿瘤医院肛肠外科

出　　处：《中华外科杂志》2013年第8期701-705,共5页Chinese Journal of Surgery

摘　　要：目的研究直肠腔内超声进行直肠癌T分期与N分期的准确性。方法回顾性分析2007年1月至2010年3月收治的319例直肠癌患者临床资料，其中男性175例，女性144例，年龄22—82岁（中位年龄59岁），根据就诊时间把患者分为A（2007年1—12月）、B（2008年1—12月）、C（2009年1月至2010年3月）3组。所有患者术前均行直肠腔内超声检查，其中272例术前超声由医师甲（n=162）、乙（n=64）及丙（n=46）完成。对比超声分期与手术后病理分期结果，评价直肠腔内超声对直肠癌浸润深度（T分期）和局部淋巴结转移（N分期）的准确性。结果本组患者术前超声T分期的准确性为67％，uT2、uT3期准确率分别为43％、81％，差异有统计学意义（x2=30．54，P〈0．01），url3、uT4a期准确率（分别为81％、59％）差异有统计学意义（X2=13．77，P〈0．01）。在行根治性手术的311例患者中，N分期准确性为66％。医师甲的T分期和N分期准确性分别为75％、72％，医师乙分别为59％、59％，医师丙分别为50％、52％。医师甲随着检查例数的增加，后期的分期准确性（T分期84％，N分期81％）较初期（T分期55％，N分期41％）明显提高（X2=6．65、13．27，P〈0．01）。结论对于熟练掌握经直肠腔内超声技术的医师，直肠腔内超声对直肠癌术前分期有较高的准确性。Objective To evaluate the accuracy of endorectal uhrasonography in preoperative staging of rectal carcinoma. Methods The 319 patients with rectal adenocarcinoma underwent endorectal uhrasonography evaluation from January 2007 to March 2010. There were 175 males and 144 females, and the age of patients were 22-82 year old （median 59 years）. According their visiting time, 319 patients were divided into 3 groups （ period A. January to December 2007 ; period B January to December 2008 ; and period C： January 2009 to March 2010）. All patients underwent endoreetal uhrasonography, and the 3 doctors had finished evaluations with 272 cases （ Doctor 1, 2, 3 had finished evaluations with 162, 64 and 46 cases respectively ）. The endoreetal ultrasonography staging was compared with the pathology findings based on the surgical specimens in 319 patients who had surgery. Results Overall accuracy in assessing the level of rectal wall invasion was 67%. The accuracy of uT2 and uT3 were 43% and 81% respectively, and the difference was statistically significant （X2 = 30. 54, P 〈 0. 01 ）, and the accuracy of uT4a was 59% , which was lower than uT3 （81% ,X2 = 13.77, P 〈0. 01 ）. Overall accuracy in assessing nodal involvement in the 311 patients treated with radical surgery was 66%. Staging accuracy tends to improve with experience, the accuracy with Doctor 1 in period C（ staging accuracy of T and N were 84% and 81% respectively） were higher than period A （ staging accuracy of T and N were 55 % and 41% respectively） （ X2 = 6. 65 and 13.27, P 〈 0. 01 ）. Conclusions Transrectal ultrasound for preoperative staging of rectal has higher accuracy with mastered ultrasound doctor.

关 键 词：直肠肿瘤 腔内超声检查 肿瘤分期 

分 类 号：R735.3[医药卫生—肿瘤]