DWI及DCE-MRI对直肠癌区域良恶性淋巴结的诊断价值

摘要： 目的 探讨机器人辅助远端乙状结肠癌和直肠癌根治术的近期临床疗效。方法 回顾性分析2016年8 月-2018年12月天津医科大学肿瘤医院12例接受机器人辅助远端乙状结肠癌 （4例） 和直肠癌根治术患者 （8例） 的临床资料， 其中男5例， 女7例， 年龄27～72岁， 中位年龄59.5岁。观察手术和术后恢复情况、 术后病理学检查情况。采用门诊及电话方式进行随访， 了解患者术后生存、 肿瘤复发和转移情况。结果 12例患者均顺利完成机器人辅助远端乙状结肠癌和直肠癌根治术， 无中转传统腹腔镜或开腹手术。12例患者的手术时间为 （282.50±90.72） min， 术中出血量为 （91.67±41.74） mL， 未发生术中并发症。12例患者中3例发生术后并发症， 肠梗阻、 吻合口漏和脑梗死各1 例。脑梗死患者转回当地继续治疗， 肠梗阻和吻合口漏患者经保守治疗后好转。术后住院时间为 （11.25±4.22） d。术后12例患者淋巴结清扫数目为 （18.50±7.75） 枚。手术切缘均为阴性， 8例直肠癌患者远切缘距离为 （2.21±0.88） cm。病理学T分期： ypT0期1例， pT1期2例， pT2期2例， pT3期5例， pT4a期2例。病理学N分期： pN0期7例， pN1期3 例， pN2期2例。病理学类型： 中分化腺癌10例， 低分化腺癌2例。12例均获得术后随访， 随访时间为1～28个月， 中位随访时间18个月。随访期间， 1例因脑梗死死亡， 其余患者均无肿瘤复发、 转移和死亡。结论 机器人辅助远端乙状结肠癌和直肠癌根治术安全可行， 近期疗效满意。

The diagnostic value of DWI and DCE-MRI for benign and malignant regional lymph nodes of rectal cancer

Abstract：Objective To study the application value of conventional MRI combined with DWI and DCE-MRI in differentiating benign and malignant regional lymph nodes of rectal cancer. Methods Preoperative MRI data of 65 patients with rectal cancer confirmed by operation and pathology were retrospectively analyzed. The accuracy of conventional MRI and conventional MRI plus DWI and DCE-MRI examination were analyzed in the diagnosis of benign and malignant lymph nodes， which was consistent with the postoperative pathology. The correlation of time-intensity curve (TIC) types， apparent diffusion coefficient (ADC) values and Ktrans ， Ve， Kep values with benign and malignant lymph nodes were also analyzed. Results The total diagnostic accuracy rate of conventional MRI for benign and malignant lymph nodes was 67.7% (317/ 468). The total diagnostic accuracy rate of conventional MRI plus DWI and DCE-MRI for benign and malignant lymph nodes was 78.2% (366/468). The benign lymph nodes were dominated by type I curve. The malignant lymph nodes were dominated by type Ⅲ curve. Ktrans ， Ve and Kep values were higher in metastatic lymph nodes than those of benign lymph nodes, and ADC values were lower than benign lymph nodes (P＜0.05). Conclusion Conventional MRI combined with DWI and DCE-MRI can improve the detection rate of regional malignant lymph nodes in rectal cancer. TIC types, ADC values and Ktrans ， Ve and K values have certain application value in differentiating benign and malignant regional lymph nodes of rectal cancer.