低张水灌肠螺旋CT扫描对大肠癌的术前分期研究

目的 评估低张水灌肠螺旋CT扫描（以下简称WESCT）对大肠癌术前分期的诊断价值和限度。方法 对48例经内窥镜活检证实的大肠癌病人，术前行螺旋CT扫描，进行螺旋CT术前TNM和Duke分期，然后与术中、术后病理各分期一一对照。结果 WESCT显示大肠癌的敏感性达97．9％（47／48）；WESCT对大肠癌TNM分期的准确率为81．3％（39／48），Duke分期的准确率为87．5％（42／48）；较文献报道的普通CT扫描的50％有明显提高。其中T分期，螺旋CT诊断的正确率为89．6％（43／48）；N分期为81．3％（39／48），3例有肝转移的病人螺旋CT均正确诊断。结论 良好的扫描方法和扫描前肠管的准确是CT对大肠癌准确分期的关键；低张水灌肠螺旋CT扫描对大肠癌的术前分期非常有价值，尤其是判断局部浸润和远处转移的情况较为准确，是目前临床综合评估大肠癌术前分期的最佳常有价值，尤其是判断局部浸润和远处转移的情况较为准确，是目前临床综合评估大肠癌术前分期的最佳影像方法；螺旋CT扫描对早期大肠癌的T分期还有一定限度，对于微小淋巴结的转移以及远处微小或潜在转移的诊断尚有一定困难。

Colorectal carcinoma: preoperative staging with water enema spiral CT

Objective　To determine the value and limitation of water enema spiral CT (WESCT) in staging of colorectal carcinoma.Methods　Forty-eight patients with histologically proven rectum or colon carcinoma were included in this study. All of them were examined by SCT ，and the preoperative staging of TNM and Duke were used based on the findings of SCT.The results of WESCT were compared with those of surgical and pathological examination in all cases. Results　All lesions in the 47 cases were demonstrated clearly by WESCT and the sensitivity was 97.9% ; 39 cases of 48 patients were correctly staged with TNM and 42 cases with Duke , the accuracy was 81.3% and 87.5% respectively, which were higher than the overall 50 % accuracy reported by references ;⑶The accuracy of WESCT was 89.6% (43/48) in T stage and 81.3% (39/48) in N stage. Three casas in M stage were all diagnosed correctly;Conclusion　WESCT scan is a better method of depicting the colorectal carcinoma. It allows for accurate depiction and staging of colorectal carcinoma, especially detecting the invasion of adjacent tissues and distant metastasis. It is the best imaging method for staging the colorectal carcinoma . However the value of WESCT for early T staging in colorectal carcinoma and minute metastasis of lymph nodes or liver is limited.