直肠腺癌和黏液腺癌腔内超声图像分析

目的探讨直肠腺癌和黏液腺癌的腔内超声图像的不同特点。方法回顾分析30例直肠进展期腺癌和28例直肠进展期黏液腺癌腔内超声特征，并与病理结果进行对比。结果进展期直肠腺癌28例腔内表面凹凸不平，肿瘤浸润肠壁回声19例无层次感，10例部分区域有模糊层次感，1例有清晰层次感。癌浸润最深处的边界17例有毛刺、呈角或呈结节样突起，5例呈波浪状起伏，8例光整平直。直肠黏液腺癌20例腔内表面平坦，肿瘤浸润肠壁回声6例有清晰层次感，13例部分区域有层次感，6例无层次感。癌浸润最深处的边界8例光滑平直，10例呈波浪状起伏，7例局部有少许毛刺、呈角或呈结节样突起。超声诊断癌浸润肠壁深度与病理诊断对比，直肠腺癌有25例诊断正确，2例诊断过浅，3例诊断过深；直肠黏液腺癌有10例诊断正确，14例诊断过浅，1例诊断过深。黏液腺癌浸润深度超声诊断符合率明显低于腺癌，且大部分为过浅诊断。结论直肠腺癌和黏液腺癌各有一定的声像图特点，对其特征的分析有助于两种癌的分型诊断。腺癌与黏液腺癌的鉴别有助于减少过浅诊断。

Investigation of endoluminal ultrasonographic characteristics of rectal adenocarcinoma and rectal mucous adenocarcinoma

Objective To investigate the endoluminal ultrasonographie characteristics of adenoearcinoma and mucous adenocareinoma of the rectum. Methods The ultrasonographie characteristics of thirty eases of advanced adenoeareinoma of the rectum and twenty-eight eases of rectal mucous adenoearcinoma were analyzed retrospectively in comparison with their eorresponding pathologic images. Results In advanced adenocareinoma of the rectum, 28 eases manifested rough endoluminal surface, of which 19 marked by thickened changes without arrangement of layers, 10 had indistinct arrangement of layers in some areas and one had clear arrangement of layers. In the deepest margin of infiltration, 17 eases manifested sentus, homed or knot-like protuberance, while 5 marked by wavy margins, and 8 cases had clear and fiat margins. In 25 eases of rectal mucous adenocareinoma, 20 manifested smooth endoluminal surface. With regard to infiltration of tumors to rectal wall, 6 cases manifested clear arrangement of layers, while 13 had clear arrangement of layers in part and 6 had no clear arrangement. In the deepest part of infiltration, 8 eases manifested slippery and fiat margins and 10 manifested wavy margins and 7 had a few sentus, homed or knot-like protuberance locally. According to ultrasonic results of the depth of infiltration to rectal wall in comparison with pathologic findings, 25 eases were diagnosed accurately, while in two cases the diagnosis was too shallow and in three eases it was too deep. In rectal mucous adenocarcinoma, 10 cases got correct diagnosis and 14 were diagnosed superficially and one got too deep. The accuracy of ultrasonic diagnosis on rectal mueoas adenoearcinoma was apparently lower than that of adenoeareinoma and most of the misdiagnosis were too superfieiai. Conclusion There are different ultrasonographie characteristics of rectal adenoeareinoma and rectal mucous adenoeareinoma, which can be helpful for the typing of rectal carcinoma and avoiding excessively superficial misdiagnosis.