经直肠超声检查在直肠癌新辅助放化疗后术前评估中的应用价值  

Value of endorectalultrasonography in preoperative assessment of rectal cancer post neoadjuvantchemoradiation therapy

作　　者：刘小银[1] 刘广健[1] 文艳玲[1] 覃斯 曹飞[1] 余俊丽[1] 陈瑶[1] 程文捷[1] 张文静 蒋清凌 王仪梅 陈丽梅 Liu Xiaoyin;Liu Guangjian;Wen Yanling;Qin Si;Cao Fei;Yu Junli;Chen Yao;Cheng Wenjie;Zhang Wenjing;Jiang Qingling;Wang Yimin;Chen Limei(Department of Ultrasonography,The Sixth Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院超声科,广州510655

出　　处：《中华医学超声杂志（电子版）》2017年第6期411-416,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨经直肠超声检查(ERUS)在直肠癌新辅助放化疗后术前评估中的应用价值。方法选择2016年1至12月中山大学附属第六医院收治的90例直肠癌患者。所有患者均接受了新辅助放化疗,并于全直肠系膜切除术(TME)前进行了ERUS,其中64例患者在新辅助放化疗前后均接受了ERUS,26例患者仅于新辅助放化疗后接受了ERUS。应用配对样本比较的Wilcoxon秩和检验比较直肠癌患者新辅助化疗前后肿瘤距肛缘距离、厚度及累及肠管长度差异。以术后病理分期诊断结果作为金标准,计算ERUS评估直肠癌新辅助放化疗后直肠癌T分期的准确性。结果与新辅助放化疗前比较,新辅助放化疗后患者肿瘤下缘距肛缘的距离增加[(51.68±19.81)mm vs(58.63±21.71)mm],肿瘤厚度减小[(14.92±5.30)mm vs(9.73±2.50)mm],肿瘤累及肠管长度缩短[(40.82±9.18)mm vs(26.10±10.07)mm],且差异均有统计学意义(Z=4.996、6.153、6.076,P均<0.01)。90例患者术后病理诊断为完全缓解p T0期15例,p T1期3例,p T2期30例,p T3期42例。术前ERUS诊断为完全缓解u T0期9例,u T1期1例,u T2期18例,u T3期59例,u T4期3例。ERUS对直肠癌新辅助放化疗后T分期的诊断准确性分别为u T0期82.2%(74/90)、u T1期96.7%(87/90)、u T2期66.7%(60/90)、u T3期67.8%(61/90)和u T4期96.7%(87/90),T分期总的诊断准确性为82.2%(74/90)。结论 ERUS能够有效记录直肠癌新辅助放化疗前后肿瘤形态学变化,有助于对肿瘤距肛缘距离、肿瘤累及范围及浸润深度进行术前再评估。Objective To investigate the value of endorectal ultrasonography（ERUS） in preoperative assessment of rectal cancer post neoadjuvant chemoradiation therapy. Methods From Jan. 2016 to Dec. 2016, 90 rectal cancer patients who underwent preoperative neoadjuvant chemoradiation therapy and total mesorectal excision surgery in the Sixth Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed, and all patients underwent ERUS examination post neoadjuvant chemoradiation therapy. Of these, 64 patients were evaluated by ERUS pre and post neoadjuvant chemoradiation therapy and 26 patients were evaluated only post neoadjuvant chemoradiation therapy. Wilcoxon rank sum test for paired sample was performed to compare the distance from inferior margin of tumor to anal margin, the length and thickness of the tumor pre and post neoadjuvant chemoradiation therapy respectively in rectal cancer. Taken pathologic findings as golden standard, the accuracy of T staging assessed by ERUS post neoadjuvant chemoradiation therapy was evaluated. Results Compared with pre neoadjuvant chemoradiation therapy, the distance from inferior margin of tumor to anal margin significantly increased after neoadjuvant chemoradiation therapy [（58.63±21.71） mm vs（51.68±19.81） mm], and the length [（26.10±10.07） mm vs（40.82±9.18） mm] and thickness [（9.73±2.50） mm vs（14.92±5.30） mm] of tumor also evidently decreased post neoadjuvant chemoradiation therapy, respectively（Z were 4.996, 6.153 and 6.076, all P〈0.01）. The final pathological T stage was pathologic complete response（p CR） or p T0 in 15 patients, p T1 in 3 patients, p T2 in 30 patients and p T3 in 42 patients. The diagnostic accuracy of T staging of rectal cancer post neoadjuvant chemoradiation therapy for ERUS was u T0 82.2%（74/90）, u T1 96.7%（87/90）, u T2 66.7%（60/90）, u T3 67.8%（61/90） and u T4 96.7%（87/90）, and the overall accuracy was 82.2%（74/90）. Conclusion ERUS could effectively record the morphological changes

关 键 词：经直肠超声检查 直肠肿瘤 新辅助放化疗 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]