下段直肠癌直肠系膜筋膜受累CT影像表现及其与术后局部复发的相关性研究  

CT Imaging Findings of Mesenteric Fascia Involvement in Lower Rectal Cancer and Correlation with Postoperative Local Recurrence

作　　者：邵楠楠 王立峰 张原理 孟帆 韩帅 海梦璐 许春苗 SHAO Nan-nan;WANG Li-feng;ZHANG Yuan-li;MENG Fan;HAN Shuai;HAI Meng-lu;XU Chun-miao(Department of Medical Imaging,The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital,Zhengzhou 450008,Henan Province,China)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)医学影像科,河南郑州450008

出　　处：《中国CT和MRI杂志》2024年第1期133-136,共4页Chinese Journal of CT and MRI

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190662)。

摘　　要：目的探究下段直肠癌(LRC)直肠系膜筋膜受累的CT影像表现,并分析其与术后局部复发的关系。方法选取本院99例于2021年1月至2023年1月接收的接受全直肠系膜切除术(TME)治疗的LRC患者,术前对患者进行增强CT检查,观察其直肠系膜(Mes)及直肠筋膜(RF)受累情况,总结CT影像特点,所有患者术后随访2年,统计局部复发率,并分析CT影像特点与患者术后局部复发的关系。结果CT对下段直肠癌T1、T2、T3和T4分期的诊断准确率分别为90.00%(9/10)、86.21%(25/29)、86.67%(39/45)和80.00%(12/15),总诊断准确率为85.86%(85/99);N分期中N0和N1诊断准确率分别为91.38%(53/58)和82.93%(34/41),总诊断准确率为87.88%(87/99);Mes和RF受累程度中不受累、Ⅰ度、Ⅱ度和Ⅲ度诊断准确率分别为86.67(13/15)、88.89%(24/27)、87.88%(29/33)和87.50%(21/24),总诊断准确率为90.91%(90/99);T分期>T3期和N分期为N1期、Mes和RF受累程度越高和存在远处转移是LRC患者局部复发的危险因素(P<0.05)。结论CT影像能准确清晰的指导LRC患者T、N分期和Mes和RF受累诊断,且T分期>T3期、N分期为N1期、Mes和RF受累程度越高和伴远处转移的下段直肠癌患者术后局部复发风险越高。Objective To explore the CT imaging findings of mesocenteric fascia involvement in lower rectal cancer(LRC)and to analyze the relationship with postoperative local recurrence.Methods 99 patients with LRC who received total mesorectal excision(TME)in our hospital from January 2021 to January 2023 were selected.Enhanced CT examination was performed before surgery to observe the mesorectum(Mes)and rectal fascia(RF)involvement,and the CT imaging characteristics were summarized.All patients were followed up for 2 years after surgery.The local recurrence rate was counted,and the relationship between CT imaging characteristics and postoperative local recurrence was analyzed.Results The diagnostic accuracy rates of CT for stages T1,T2,T3 and T4 were 90.00%(9/10),86.21%(25/29),86.67%(39/45)and 80.00%(12/15)respectively,and the total diagnostic accuracy rate was 85.86%(85/99).In N staging,the diagnostic accuracy rates of N0 and N1 were 91.38%(53/58)and 82.93%(34/41)respectively,and the total diagnostic accuracy rate was 87.88%(87/99).The diagnostic accuracy rates of non-involvement,degreeⅠ,degreeⅡand degreeⅢof Mes and RF involvements were 86.67%(13/15),88.89%(24/27),87.88%(29/33)and 87.50%(21/24)respectively,and the total diagnostic accuracy rate was 90.91%(90/99).T staging>stage T3 and stage N1,high Mes and RF involvement degrees and presence of distant metastasis were risk factors of local recurrence in patients with LRC(P<0.05).Conclusion CT imaging can accurately and clearly guide the diagnosis of T staging and N staging and Mes and RF involvements in patients with LRC,and the risk of postoperative local recurrence is high in lower rectal cancer patients with T staging>stage T3,stage N1,high degrees of Mes and RF involvements and distant metastasis.

关 键 词：直肠癌 系膜 筋膜 CT影像 术后局部复发 

分 类 号：R735.37[医药卫生—肿瘤]