超声内镜对直肠癌术前分期的准确性及对经肛门内镜显微手术的指导意义  

Accuracy of endoscopic ultrasound in the preoperative staging and the guidance of transanal endoscopic microsurgery for rectal cancer

作　　者：蔡许超[1] 刘广伟[1] 卢云[1] 尹万斌[1] 

机构地区：[1]青岛大学附属医院黄岛院区普通外科,266000

出　　处：《中华胃肠外科杂志》2015年第5期487-490,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：青岛市市南区科技发展计划项目（2012-5-018-YY）

摘　　要：目的：探讨超声内镜（EUS）对直肠癌术前分期诊断的准确性及对早期直肠癌行经肛门内镜显微手术（TEM）的指导意义。方法回顾性分析2012年6月至2013年12月间青岛大学医学院附属医院黄岛院区普通外科收治的80例采用EUS检查进行术前分期的直肠癌患者临床资料，将EUS术前分期与病理分期进行一致性比较，分析术前EUS分期的准确性，并根据术前分期对早期直肠癌（Tis或T1N0M0）且病变位于肛门20 cm内的患者行TEM治疗。结果 EUS评估直肠癌术前T分期的总体准确率为68．8％（55／80），评估T1、T2、T3及T4期准确率分别为91．3％（73／80）、83．8％（67／80）、77．5％（62／80）和85．0％（68／80）；与术后病理T分期一致性较好（Kappa＝0．562）。EUS评估直肠癌术前N分期的总体准确率为52．7％（39／74），对N0、N1及N2分期的准确率分别为64．9％（48／74）、55．4％（41／74）和85．1％（63／74），与术后病理N分期一致性差（Kappa＝0．235）。对EUS评估为T1N0的6例患者顺利施行了TEM，平均手术时间99（65～123） min，无术中及术后严重并发症发生，术后2～3 d出院；术后1月复查肠镜，均愈合良好，中位随访14．8（11～19）月，未发现局部复发及远处转移。结论 EUS对直肠癌术T分期准确性较高，对早期直肠癌TEM治疗有指导意义。Objective To explore the accuracy of endoscopic ultrasound （EUS） in preoperative staging of rectal cancer and to guide the treatment of transanal endoscopic microsurgery （TEM） in early rectal cancer. Methods Clinical data of 80 patients with rectal cancer receiving EUS examination for preoperative staging in our department between June and December 2012 were retrospectively analyzed. Consistence comparison of EUS preoperative staging and pathological staging was performed to identify the accuracy of EUS preoperative staging. All the patients underwent operation within 1 week after EUS examination. According to preoperative staging, early rectal cancer （Tis or T1N0M0） patients with lesions less 20 cm to anus underwent TEM. Results The overall accuracy of EUS for preoperative T stage was 68.8%（55/80）, and for T1, T2, T3, T4 was 91.3%（73/80）, 83.8%（68/80）, 77.5%（62/80）, 85.0%（67/80）, which had a good consistence with postoperative pathological T staging （Kappa=0.562）. The overall accuracy of EUS for preoperative N stage was 52.7%（39/74）, and for N0, N1, N2 stage was 64.9%（48/74）, 55.4%（41/74）, 85.1%（63/74）, which had a poor consistence with postoperative pathological N staging （Kappa=0.235）. Six patients underwent TEM successfully, with mean operation time 99（65 to 123） min, without intraoperative and postoperative complication, and were discharged 2-3 days after operation. Enteroscope showed good recovery 1 month later. Pathology confirmed that all the lesions were early rectal cancer. During postoperative follow-up of 14.8 （11 to 19） months, there was no local recurrence and distant metastasis. Conclusion Preoperative EUS has a good accuracy with pathologic T stage, and can guide TEM in early rectal cancer.

关 键 词：超声内镜 术前分期 直肠肿瘤 早期 经肛门内镜显微手术 

分 类 号：R735.37[医药卫生—肿瘤]