经直肠超声术前评估直肠癌保肛与非保肛手术方案的选择

The preoperative evaluation with transrectal ultrasound in prediction of anus preserved for rectal cancer

目的探讨经直肠超声(Transrectal ultrasound,TRUS)术前评估直肠癌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≤10 cm者49例,其中行保肛手术38例,非保肛手术11例。所有患者术前行TRUS评估,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UT分期与术后PT分期有关,而与术后PN分期无关。肿瘤下缘距齿状线距离,当此距离≥7 cm时一律选用保肛手术;当此距离<7 cm时,若肿瘤厚度<13 mm时,一般选用保肛手术。结论运用TRUS对直肠癌患者行术前评估,可以得到肿瘤厚度,肿瘤下缘距齿状线距离和uT分期3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 investigate the value of transrectal ultrasound （TRUS） in prediction of anus preserved for rectal cancer. Methods 49 patients with rectal cancer were involved in the present study, whose distance of tumor to dentate line was more than 10cm. The patients were evaluated with TRUS, preoperatively, including 38 cases with anus preserving operation and 11 with transanal local excision. The stage of TRUS and operative procedures were compared before and after operation. Results The accuracy of uT and uN stages with TRUS preoperative evaluation were 91.8% and 51.2 %, respectively. The tumor thickness was statistically relative with different operative procedures （P= 0. 002） with analysis of potential factors. There was significant correlation between distance of tumor to dentate line （P=0. 000） and tumor thickness （P=0. 002） and operative procedures. Conclusion The objective parameters of rectal cancer with TRUS including distance of tumor to dentate line, tumor thickness and uT stages are valuable for preoperative assessment for rectal cancer.