超声小探头对结直肠癌术前分期诊断的初步研究

目的：超声小探头（ultrasonic miniprobe,UMP）应用于结、直肠癌术前分期的准确性及可行性。方法：对50例结、直肠癌患者做UMP检查，对准病灶进行全瘤扫描，择最佳影像冻结、摄片，退出UMP，最后做活组织检查，全部病例均行根治术，癌周淋巴结分组编号、装瓶、送病理检查。结果：本组UMP对50例结、直肠浸润深度（T分期）与术后病理浸润深度对比，其准确率T1－T4期分别为75％，80％，88％及67％，T分期的总准确率为84％（P＜0．01），过高分期5例（10％），过低分期3例（6％）；N分期，UMP诊断阳性淋巴结（n=22)，术后病理（n=28)，准确率795，UMP诊断阴性淋巴结（n＝20），术后病理（n＝22），准确率91％，总准确率84％（42／50），敏感性79％，特异性为91％（P＜0．01）。结论：（1）UMP是当前应用于结、直肠癌术前TNM分期最有实用价值的方法之一。肿瘤狭窄患者适应术前分期检查。（2）UMP系高频超声频探头，由于超声穿透深度的限制。对远处转移的M分期是不可能的。（3）UMP对浸润深度及处淋巴结转移有一定的参考价值。并应结合其它影像检查如腹部B超、CT等，扬长弃短，相辅相成，以提高术前分期的准确性及完整性。

Pre liminary study on preoperative TNM staging with ultrasonic mini- probe in diagnosis of colorectal cancer

Objective To study on the feasibility and accuracy of ultrasonic mini-probe (UMP) for preoperative TNM staging in diagnosis of colorectal cancer. Methods In fifty patients with colorectal cancer preoperative TNM category examinations were performed by UMP(12 MHz/20 MHz), and compared UMP findings with pathological outcomes after surgical resection. Results The accuracy of UMP in diagnosis of infiltrative depth (T staging) of colorectal cancer was 75%(uT1), 80%(uT2), 88%(uT3), and 67%(uT4), respectively, and the total accuracy was 84% in all cases (P< 0.01). The total accuracy of UMP in diagnosis of lymph node metastasis (N staging) was 84% in all cases (P< 0.01), the sensitivity and specificity was 79% and 91%, respectively . The positive and negative predictive value was 92% and 77%, respectively. Conclusions (1) UMP is, at present, one of the most valuable practicable procedures in preoperative TNM staging of colorectal cancer, especially, in some patients with in filtrative malignant stenosis;(2) UMP is impossible for M staging with distant metastasis due to the limitation of penetrating depth of high frequency ultrasound; (3) UMP in diagnosis of preoperative TNM staging of colorectal cancer should be combined with other imaging techniques ,for example, abdominal B scan, CT and so forth, so as to improve the accuracy and integrity of preoperative staging in colorectal cancer.