经直肠超声检查术前评估直肠癌累及程度的临床研究

目的探讨术前经直肠超声检查(TRUS)对直肠癌累及程度的评估作用。方法对58例原发性直肠癌的患者术前行TRUS检查,测量肿块大小及肿块内血流阻力指数(RI),并对其浸润深度进行判断,将检查结果与术后病理进行对照,Kappa检验评估两者结果的一致性。结果 TRUS评估直肠癌累及程度总的准确率为84.5%,T1^T4期TRUS诊断准确率分别为96.6%、91.4%、87.9%及93.1%,与病理分期有较高的一致性(Kappa=0.767,P=0.000)。早期直肠癌组肿块上下径(1.1±0.3)cm,厚度(0.6±0.2)cm,进展期直肠癌组肿块上下径(2.9±0.6)cm,厚度(1.7±0.5)cm,两组上下径及厚度比较差异均有统计学意义(P<0.05)。早期直肠癌组RI值0.72±0.05,进展期直肠癌组RI值0.65±0.07,两者之间差异有统计学意义(P<0.05)。结论 TRUS术前评估直肠癌累及程度具有较高的准确性,对治疗方案的制定提供了依据。

Preoperative evaluation of tumor invasion depth in rectal cancer by transrectal ultrasound

Objective To explore the role of preoperative assessment in tumor invasion depth（T-staging） of rectal cancer by transrectal ultrasound（TRUS）. Methods 58 patients with rectal cancer underwent TRUS before surgery to predict T-staging, the tumor size and resistance index（RI） of arteries in rectal cancers were detected.The results were compared with the postoperative pathological examination.Their consistency was evaluated by Kappa test. Results The total accuracy rate of TRUS in T-staging of rectal cancer was 84.5%. The diagnostic accuracy rates in T1-T4 stage by TRUS were 96.6%, 91.4%, 87.9% and 93.1%. The ultrasound staging was highly consistent with the pathological staging（Kappa=0.767, P=0.000）. The tumor vertical diameter and thickness of early rectal cancer group were（1.1±0.3）cm and（0.6±0.2）cm, while the tumor vertical diameter and thickness of advanced rectal cancer group were（2.9±0.6）cm and（1.7±0.5）cm. The difference of vertical diameter and thickness between the two groups was statistically significant（P〈0.05）. The RI value of early rectal cancer group was 0.72±0.05, while the RI value of advanced rectal cancer group was 0. 65±0.07. The difference of the RI value between the two groups was statistically significant（P〈0.05）. Conclusion TRUS has a better accuracy in preoperative assessment of the depth of tumor invasion in rectal cancer and provides the basis for the planning of treatment.