大肠癌同期肝转移的术中B超诊断及危险因素

目的:研究术中B超(IOUS)诊断大肠癌同期肝转移的价值,分析大肠癌同期肝转移危险因素,探讨IOUS的临床应用.方法:对上海市第六人民医院2008年3月—2011年6月诊治的427例大肠癌采用IOUS对肝脏行全方位检查以诊断肝转移,收集临床资料,选择性别、年龄、肿瘤部位、病理分化程度、病灶浸润程度、淋巴结转移情况、病灶大小及术前血清CEA水平等临床因素,进行单因素和多因素分析.结果.427例患者中有83例合并同期肝转移,占19.4％.术前联合应用B超、CT确诊肝转移65例,其中8例IOUS发现肝脏另有转移灶；IOUS新发现肝转移18例.IOUS准确性为96.0％,明显高于术前联合应用B超、CT 84.5％ (P＜0.05).病灶浸润程度、淋巴结转移情况、病灶大小及术前血清CEA水平与同期肝转移呈正相关(P＜0.05).结论:IOUS对探查大肠癌同期肝转移具有较高诊断价值.术中发现肿瘤直径≥4.O cm、肿瘤累及肠壁全层、淋巴结转移、术前血清CEA水平升高的大肠癌患者发生同期肝转移的危险性较大,应加强对肝脏的探查,有条件者可行IOUS检查.

Intraoperative ultrasonographic diagnosis of synchronous hepatic metastases from colorectai cancer and related risk factors

Objective： To study the value of intraoperative ultrasonography（IOUS） in the diag- nosis of synchronous hepatic metastases from colorectal cancer, analyze risk factors on synchronous hepatic metastases and discuss the clinical application of IOUS. Methods： Thorough IOUS exami-nation of the liver was performed for the diagnosis of hepatic metastases in 427 cases with colorec- tal carcinoma between March 2008 and June 2011, while clinical data was collected. Clinicopatho- logic features including sex, age, location of tumor, differentiation degree, infiltrating depth, lymph node metastasis, tumor size and preoperative serum CEA level were studied, Univariate analysis and multinomial logistic regression and correlation analysis were carried out to evaluate the factors con- cerned. Results＇. Among these 427 cases, there were 83 with synchronous hepatic metastases, accounting for 19.4%.Preoperative ultrasonography examination in combination with CT scan con- firmed hepatic metastases in 65 cases, and in 8 of them, IOUS identified more metastatic lesions. 18 new cases with hepatic metastases were diagnosed at IOUS. The accuracy of IQUS was 96.0%, and significantly higher than that of preoperative ultrasonography examination in combination with CT scan（84.5%, P〈 0.05）, Infiltration depth, lymph node metastasis, tumor size and preoperative serum CEA level were positively related with synchronous hepatic metastasis （P 〈 0.05）. Conclusion： IOUS has a high diagnostic value in the detection of synchronous hepatic metastasis from colorectal cancer. When the tumor not less than 4.0 cm in diameter, or the invasion of all the layers of large in- testinal wall, or lymph node metastasis is detected in operation, or preoperative level of serum CEA is elevated, the risk of synchronous hepatic metastasis obviously increased,the exploration of the liver should be strengthened and IOUS is recommended for conditional cases.