肠镜检查对大肠癌术前分期及指导治疗的意义

目的 探讨肠镜检查对大肠癌诊断及术前分期的价值,并评价术前确定大肠癌分期对指导治疗的意义。方法 通过系统地采用电子结肠镜、放大电子肠镜、超声大肠镜检查,对28例大肠癌患者进行了术前分期,并制定了相应的治疗方案。结果 本组资料28例经系统的肠镜检查诊断,分为早期癌组15例,进展期癌组13例,术前分期与术后病理的符合率为100％;浸润深度与病理诊断的符合率为89％（25／28）。早期癌组中,11例病变局限于粘膜层,4例局限于粘膜下层,对其中6例距肛门小于6cm的早期直肠癌患者,选择了肠镜下切除或局部手术切除的治疗方法,至目前随访12－40个月,肠镜检查均无复发。结论 术前对大肠癌正确的临床分期在治疗选择,特别是早期癌的治疗选择方面具有指导意义。在强调治愈性切除的基础上,使大肠癌的手术治疗更具个体化和科学性,从而提高患者的术后生存质量。

Colonoscopy in preoperative staging and treatment of colorectal cancer

Objectives To investigate the value of colonoscopy for the diagnosis and preoperative staging of colorectal cancer, and evaluate the significance of correct preoperative staging in guiding treatment. Methods 28 patients with colorectal cancer were examined by general colonoscopy, magnifying endoscopy and endoscopic ultrasonography before operation. Preoperative staging, and proper treatment protocols were made. Results Endoscopy revealed that 15 of the 28 patients had early colorectal cancer and 13 advanced colorectal cancer. The correct diagnosis rate for preoperative staging was 100%; the accuracy of penetrating depth was 89%(25/28). In the early cases, tumour invasion was confined to mucosal layer in 11 patients and submucosal layer in 4. Six patients with early cancers 6 cm from the anus were treated by endoscopic mucosa resection (EMR) or EMR combined with open surgery. No postoperative recurrence was found by endoscopy during the period of follow up for 12 40 months.Conclusion Correct preoperative staging for colorectal cancer is of important significance in guiding treatment, especially in early staging cases. In order to improve the quality of life for colorectal cancer patients, we should treat them with individualized operation based on curative resection.