端扫式直肠探头在直肠肿瘤诊断中的应用

Transrectal ultrasound with head scanning probe in diagnosing rectal tumors

目的探讨端扫式直肠超声探头在直肠良恶性肿瘤诊断中的应用价值。方法采用端扫式直肠探头对121例直肠良恶性肿瘤患者行术前直肠腔内超声检查(TRUS)及直肠癌超声分期诊断,并与手术病理诊断及分期结果对照分析。结果121例直肠肿瘤病理诊断良性14例(绒毛管状腺瘤7例,绒毛状腺瘤4例,管状腺瘤3例);病理诊断恶性107例(隆起型腺癌44例,溃疡型腺癌50例,类癌6例,恶性黑色素瘤4例,淋巴瘤3例)。术前直肠腔内超声检出腺瘤12例(12/14),均为中低位肿瘤,2例误诊为直肠癌,与病理诊断符合率为85.7%;术前腔内超声检出直肠恶性肿瘤106例(106/107),99例为直肠癌(低位肿瘤35例,中位肿瘤28例,高位肿瘤36例),仅漏诊1例直肠癌,术前直肠腔内超声与病理诊断符合率为99.1%。直肠良性肿瘤超声表现为高回声结节,恶性肿瘤均表现为低回声团块。与病理分期结果对照显示,100例直肠癌腔内超声分期诊断的准确率为84.0%(84/100);对直肠癌周围淋巴结转移诊断的敏感性为90.6%,准确性为85.9%。直肠腔内超声可清晰完整显示中低位和高位直肠癌肿块图像,其检测高位直肠癌(30/36,83.3%)与中低位直肠癌的准确率(54/63,85.7%)比较差异无统计学意义(P>0.05)。结论端扫式直肠腔内超声检测对直肠癌术前分期有重要价值,对高位或肠腔明显狭窄的直肠癌诊断有明显的优越性。对肿瘤较大(直径≥3cm)及基底宽的腺瘤应考虑有恶变的可能。利用直肠内水窗检查以及良好的检查手法操作及技巧是提高直肠腔内超声检查成功率与准确性的关键。

Objective To probe the methods and clinical value of transrectal ultrasound （TRUS） in detecting rectal tumors with head scanning probe. Methods One hundred twenty one patients underwent TRUS with the head scanning probe. Preoperative ultrasonic findings were compared with the pathological results. Results Rectal malignant tumors appeared as hypoechoic masses and benign tumors appeared as hyperechoic nodi on TRUS, which had an overall accuracy rate of 84.0% in rectal cancer staging. The sensitivity and accuracy of TRUS in the diagnosis of lymph node metastasis were 90.6% and 85.9% , respectively. There was no statistical difference of rectal carcinoma in the upper and lower level. Conclusions TRUS with head scanning probe is of great value for the pre-operative staging of rectal carcinoma, and it has special advantages for upper level rectal carcinoma and rectal malignant stenosis. Rectal water window and intestinal physiological curves are beneficial for multi-angle scanning to make the detected direction perpendicular to the lesions so as to get precise and perfect imaging resulting in TRUS diagnostic accuracy.