直肠癌术前经直肠超声评估保肛或非保肛手术方案的临床前瞻性研究

The preoperative application of transrectal ultrasound to prospectively predict the sphincter sparing or non-sparing operations for rectal cancer

目的探讨直肠癌术前应用经直肠超声(transrectal ultrasound,TRUS)评估对于预测保肛与非保肛手术方案选择的价值。方法纳入病理诊断为直肠癌且肿瘤下缘距齿状线≤10cm者49例,记录术前TRUS分期和预计手术方案,与术后病理分期和实际手术方案进行比较。结果TRUS术前评估得到uT分期准确度为91.8%,uN分期准确度为51.2%。Logistic回归分析显示,肿瘤厚度(以13mm为分界点)为保肛手术方案的危险因素(回归系数=2.784,P=0.013)。当同时满足肿瘤厚度≥13mm和uT4期时,行非保肛手术的可能性为41.7%;而当TRUS提示肿瘤厚度<13mm时能成功实施保肛手术的可能性为96.0%。结论运用TRUS对直肠癌患者行术前评估,可以得到肿瘤厚度和uT分期2个影响手术方案的客观指标,为临床医师预测保肛或非保肛手术方案提供依据。

Objective To assess the value of transrectal ultrasound （TRUS） used in the preoperative evaluation of rectal cancer to predict the sphincter sparing or non - sparing operations. Methods Forty - nine patients pathologically proved rectal cancer with distance of tumor to dentate line ≤ 10 cm were recruited, and all of them received TRUS assessment preoperatively. Preoperative TRUS stage and predictive operative procedures were recorded and compared with postoperative pathological stage and practical operative procedures. Results The accuracy of uT and uN stages, resulting from TRUS preoperative evaluation was 91.8% and 51.2% , respectively. The Logistic models showed that tumor thickness was a statistically risk factor of sphincter sparing operation （ regression coefficient = 2. 784, P = 0. 013 ）. The possibility of developing sphincter non - sparing operation was 41.7% , when sufficing both tumor thickness t≥ 13 mm and uT4 stage; to contrary, the possibility of performing sphincter sparing operation reached 96.0% when tumor thickness 〈 13 mm was referred by TRUS. Conclusion The objective parameters influencing development of operative procedures, involving tumor thickness and uT stages, can be rendered by TRUS preoperative assessment, which served as valuable reference for clinical decision of operative procedures in rectal cancer.