多排螺旋CT对间位结肠癌术前分期的研究  

ASSESSMENT OF PREOPERATIVE STAGING USING MULTIDETECTOR COMPUTED TOMOGRAPHY FOR NONPERITONEALIZED COLON CANCER

作　　者：丁国良[1] 张志勇[2] 王军[3] 

机构地区：[1]华北理工大学附属唐山工人医院,河北省唐山市063000 [2]唐山工人医院病理科 [3]唐山工人医院胃肠外科

出　　处：《中国煤炭工业医学杂志》2016年第3期354-359,共6页Chinese Journal of Coal Industry Medicine

基　　金：河北省医学科学研究重点课题计划(编号:20120182)

摘　　要：目的应用多排螺旋CT（multidetector computed tomography,MDCT）对间位（升结肠或降结肠）结肠癌进行术前分期,为结肠癌的术中及术后治疗提供影像学参考。方法回顾性分析2009年1月—2015年1月唐山工人医院胃肠外科收治的Ⅱ期间位结肠癌189例。通过术前多排螺旋CT进行评估,比较各组预后差异。结果多排螺旋CT进行T分期：T1期0例、T2期0例、T3期72例、T4期117例,其中T3期和T4期5年总体生存率（overall survival,OS）及3年无病生存率（disease-free survival,DFS）差异有统计学意义（P均〈0.05）;比较65例病理学T分期为pT4期的结肠癌患者可见化疗能够明显提高患者的5年OS（χ^2=5.066,P=0.024）,但不能提高3年DFS（χ^2=2.646,P=0.104）。在Cox风险回归评估中,影像学T分期可以作为Ⅱ期间位结肠癌5年OS（RR=2.809,95%CI：1.006-7.843,P=0.049）及3年DFS（RR=1.293,95%CI：1.849-9.078,P=0.001）相关的独立因素。结论多排螺旋CT能够较好的进行结肠癌的术前分期,影像学T分期可以成为影响结肠癌预后的独立因素,有望为间位结肠癌术中决策或术前新辅助化疗提供影像学参考。Objective To evaluate the value of preoperative staging by multidetector computed tomography for nonperitonealized colon cancer,and to provide evidence for the intraoperative decision making and postoperative therapy.Methods From January 2009 to January 2015,the 189 patients of II staging nonperitonealized colon cancer at the department of general surgery,Tangshan Workers＇ 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 According to the imaging T staging assessment conducted a total of T3 stage 72 cases and 117 cases of T4 stage.And two groups of 3 DFS and5 OS were significantly different（P〈0.05）.What＇s more,according to the pathological standards,compared with 65 cases of colon cancer patients with pT4 stage,chemotherapy could significantly improve the prognosis of the patients.Multi-variant analysis showed that radiological T staging could be served as independent prognostic factors.Conclusions MDCT owns a capability of pre-operative staging for the nonperitonealized colon cancer and the radiological T staging is the independently prognostic factor in colonic neoplasms.Therefore they can hopefully provide the radiological evidence for a change in the intraoperative surgical plan,or indicate the need for preoperative neoadjuvant therapy.

关 键 词：结肠肿瘤 多排螺旋X线计算机体层成像 T分期 术前分期 

分 类 号：R735.35[医药卫生—肿瘤]