多排螺旋CT对无腹膜覆盖的结肠癌术前分期的研究  

Preoperative staging by multidetector computed tomography for nonperitonealized colon cancer

作　　者：崔艳成[1] 丁国良[3] 郭鹏[1] 王屹[2] 姚旬[1] 杨素行[1] 高志冬[1] 王军[3] 叶颖江[1] 

机构地区：[1]北京大学人民医院胃肠外科,100044 [2]北京大学人民医院放射科, 100044 [3]唐山工人医院普外科

出　　处：《中华普通外科杂志》2016年第3期197-200,共4页Chinese Journal of General Surgery

摘　　要：目的 应用多排螺旋CT（multidetector computed tomography,MDCT）对无腹膜覆盖的结肠癌进行术前分期,分析不同分期患者的预后情况.方法 回顾性分析2009年1月至2014年12月间在北京大学人民医院胃肠外科ⅡA（T3N0M0）期无腹膜覆盖的结肠癌97例患者的临床资料.通过术前多排螺旋CT的评估,比较评估结果与预后的差异.结果 多排螺旋CTT分期情况：T2期1例、T3期33例和T4期63例,其中T3期和T4期3年无病生存率（disease-free survival,DFS）差异有统计学意义（x2 =9.174,P=0.002）;在Cox风险回归评估中,T分期为无腹膜覆盖的结肠癌3年DFS的独立的危险因素（RR=5.919,95％ CI：1.301～26.933,P=0.021）.多排螺旋CT对肿瘤浸润深度（extramural tumor depth,EMD）进行测量：EMD＜1 mm者13例、EMD在1～5 mm者31例、EMD在5～15 mm者39例、EMD＞ 15 mm者14例,其中EMD 1 ～5 mm与5～ 15 mm比较,3年DFS x2=4.549,P=0.033）及5年总体生存率（overall survival,OS）（X^2=10.315,P=0.001）差异均有统计学意义,在Cox风险回归评估中,EMD为无腹膜覆盖的结肠癌5年OS的独立因素（RR=8.001,95％ CI：1.657 ～ 38.664,P=0.010）.结论 多排螺旋CT能够进行结肠癌的术前分期,其T分期及EMD可作为影响结肠癌预后的独立危险因素.Objective To evaluate preoperative staging by multidetector computed tomography （MDCT） for nonperitonealized colon cancer.Methods From January 2009 to December 2014,97 staging Ⅱ A nonperitonealized colon cancer patients at the Department of General Surgery,Peking University People＆#39;s Hospital were enrolled in the study.Radiological T staging was evaluated through preoperative MDCT and statistical analysis was performed to evaluate the prognosis of different stages.Results There were 1 case of T2 stage,33 cases of T3 stage and 63 cases of T4 stage.Patients with radiological T3 and T4stages had significantly different survivals （x2 =9.174,P =0.002）.According to the imaging standards,tumor invasion depth （extramural tumor depth,EMD） was estimated as 13 cases of EMD 〈 1 mm,31 cases of1 mm≤EMD≤5 mm,39 cases of 5 mm〈EMD〈15 mm,14 cases ofEMD〉15 mm.The 3 year＆#39;s disease-free survival was significantly different between groups of EMD 1-5 mm and 5-15 mm （x2 =4.549,P =0.033）.The 5-year overall survival was also significantly different （x2 =10.315,P =0.001）.Multi-variate analysis showed radiological T staging （RR =5.919,95% CI：1.301-26.933,P =0.021） and EMD （RR =8.001,95% CI：1.657-38.664,P =0.010） were independent prognostic factors.Conclusions MDCT can make pre-operative staging for the nonperitonealized colon cancer and this radiological T staging and EMD are independent poor prognostic factors in colonic neoplasms.

关 键 词：结肠肿瘤 体层摄影术 螺旋计算机 肿瘤分期 

分 类 号：R814.42[医药卫生—影像医学与核医学]