脂肪对比剂灌肠螺旋CT在结直肠癌术前分期中的作用

Preoperative staging of colorectal carcinoma using fat-dense contrast medium enema and helical CT

目的 探讨脂肪对比剂螺旋CT对结直肠癌术前分期的价值。方法 回顾性分析 2 9例经手术病理证实的结直肠癌患者术前脂肪对比剂灌肠螺旋CT资料 ,扫描前充分肠道准备、肌注低张剂后 ,经直肠导管注入脂肪对比剂 (CT值 -2 0 0～ -2 40 ) 15 0 0ml ,行螺旋CT增强扫描 ,扫描范围从膈顶至耻骨联合。结果 脂肪对比剂灌肠低张螺旋CT总的分期准确率为 65 .5 % (19/ 2 9)。B期分期的准确率为 75 % (9/ 12 ) ;C期分期的准确率 63 .6% (7/ 11)。肿瘤浆膜外侵犯的敏感性和特异性分别为 92 % (2 3 / 2 5 )和 5 0 % (2 / 4)。淋巴结转移的敏感性和特异性分别为 60 % (12 / 2 0 )和 90 % (9/ 10 )。结论 超低密度脂肪对比剂螺旋CT对结直肠癌术前分期有重要意义 ,有助于判断肿瘤浆膜外侵犯及淋巴结和远处转移。

Objective To evaluate the role of preoperative staging of colorectal carcinoma using fat dense contrast medium enema and helical CT. Methods Twenty nine patients with known or suspected colorectal carcinoma underwent enhanced helical CT, from the dome of the diaphragm to symphysis pubica, after bowel cleaning, administration of smooth muscle relaxant, and rectal fat dense contrast agent insufflation. Colonoscopies were performed on all patients. All patients were treated with surgery, and the findings of helical CT were compared with histopathological results for staging. Results The overall accuracy rate of helical CT of staging with the modified Dukes' classification was 65.6% (19/29). The accuracy rate of stage B and stage C were 75% (9/12)and 63.6% (7/11), respectively. Sensitivity and specificity for serosal infiltration were 92% (23/25)and 50% (2/4), respectively. Sensitivity and specificity for lymph node involvement were 60% (12/20)and 90% (9/10), respectively. Conclusion CT is useful to assess the serosal infiltration, lymph node involvement and distant metastasis with fat dense contrast medium enema and helical scanning, and playing a significant role in preoperative staging of colorectal carcinoma.