结肠癌患者术前TNM分期、MSCT影像表现及病理表现特点分析

目的探讨结肠癌患者术前TNM分期、多层螺旋CT扫描(MSCT)影像表现及病理表现特点分析。方法回顾性分析2009年3月-2012年我院肿瘤外科收治的经手术病理证实的40例结肠癌患者临床资料,病例患者均行MSCT影像学检查,对所有病例患者临床资料进行回顾性分析,以评估MSCT影像技术在诊断结肠癌的应用价值。结果 MSCT诊断结肠癌患者术前TNM分期诊断准确例数为35例(87.50%),2例术前T1-2期过低评估,术前病检为T3期、T4期例数分别为1、1;且T3期中过低估计为T1-2期、过高估计为T4期例数分别为0、1;T4期中过低估计为T1-2、过低估计为T3期例数分别为1、1,均差异有统计学意义(P0.001)。结肠癌MSCT影像学表现肠壁不规则增厚,肠腔内外肿块,肠腔较狭窄,增强CT扫描显示不同程度强化的肿块,强化特点紧系于分化程度,而受侵部位有浆膜和其邻近器官,浆膜面较毛糙亦或周围脂肪层很模糊,有的甚至伴有浆膜外索条影,表明周围脏器亦受侵,而区域淋巴结转移,紧系于肿瘤病灶部位和相对应的淋巴结回流,而肝脏是最为常见的远处转移脏器。患者经术后组织病理检查提示,腺癌、印戎细胞癌、管状腺癌、粘液腺癌、乳头状腺癌、低分子型腺癌例数分别为18、3、5、8、3、3。结论 MSCT对结肠癌患者术前TNM分期有较好的评估价值,有一定临床应用价值。

Analysis of the Preoperative TNM Staging,MSCT Imaging Findings and Pathological Features of Patients with Colon Cancer

Objective To investigate the preoperative TNM staging, multi-slice spiral CT (MSCT) imaging findings and pathological features of patients with colon cancer. Methods The clinical data of 40 patients with colon cancer confirmed by surgery and pathology in our hospital between March 2009 and 2012 were retrospectively analyzed. MSCT was performed in all patients. The clinical data of all patients were analyzed retrospectively to evaluate the application value of MSCT imaging technology in the diagnosis of colon cancer.Results Thepreoperative TNM staging of patients with colon cancer was correctly diagnosed by MSCT in 35 cases(87.50%). For stage T1-2, there were 2 cases underestimated before operation. Pathological test showed that 1 case was stage T3 and 1 case was stage T4. There were 0 cases in stage T3 underestimated as stage T1-2 and 1 case overestimated as stage T4. In stage T4, there was 1 caseunderestimated as stage T1-2 and 1 caseunderestimated as stage T3. The diagnostic test consistency test showed Kappa=0.680(P<0.001). CT imaging findings of colon cancer showed intestinal wall thickened irregularly, masses inside and outside the lumen and relatively narrower intestinal cavity. Enhanced CT scanning showed masses with different degrees of enhancement, and the enhanced features was related to the degree of differentiation, while serosa and its adjacent organs were invaded. The serosal surface was coarse and surrounding fat layer was fuzzy, or with serosal stripped shadow, indicating that the surrounding organs were invaded, with regional lymph node metastasis, which was related to the location of tumor and reflux of the corresponding lymph nodes. Distal liver metastasis was common in organ metastasis. The postoperative pathological examination showed that Adenocarcinoma,signet ring cell carcinoma, tubular adenocarcinoma, mucinous adenocarcinoma, papillary adenocarcinoma, low molecular type adenocarcinoma cases were 18, 3, 5, 8, 3, 3.Conclusion MSCT is of good value in the evaluation of preoperative TNM staging of patients with colon cancer.