阳性对比剂灌肠螺旋CT盆腔平扫对中晚期直肠癌的术前T分期的诊断价值

Value on the Preoperative T Staging of Middle-late Stage Rectal Carcinoma with Pelvic Spiral CT Using Positive Agent Enema

目的:评估阳性对比剂灌肠螺旋(S)CT盆腔平扫对直肠癌术前T分期的诊断价值和限度。方法:回顾性分析82例中晚期直肠癌患者的SCT资料,本组术前行阳性对比剂灌肠SCT盆腔平扫,将盆腔SCT扫描T分期与术后病理T分期对照。结果:阳性对比剂灌肠SCT盆腔扫描对中晚期直肠癌T分期的准确率为76.8%(63/82)。本组仅行SCT盆腔平扫,未行双期增强扫描,其中6例有明显外侵及淋巴结转移,浸润邻近组织器官或淋巴结转移的病例,放、化疗后再手术切除。结论:良好的扫描方法和扫描前肠道的认真准备是CT对直肠癌术前准确分期的关健;阳性对比剂灌肠SCT盆腔扫描对直肠癌术前T分期非常有价值,是目前直肠癌术前T分期较好的影像方法;SCT扫描对早期直肠癌的诊断还存在一定限度。

Objective： To evaluate the diagnosis value and limitation on the preoperative T staging of middle-late stage rectal carcinoma with pelvic spiral（S）CT using positive agent enema. Methods： The data of 82 patients（pelvic SCT using positive agent enema before operation）with middle-late stage rectal carcinoma were retrospectively analyzed. T staging by pelvic SCT was compared with that by postoperative pathology. Results： The accuracy of T staging of middle-late stage rectal carcinoma with pelvic SCY using positive agent enema was 76.8%. The pevlic SCT was performed in 82 patients without enhancement scanning. Obvious invasion and lymph node metastasis were found in 6 patients. The cases with adjacent organ invasion or lymph node metastasis underwent second operation after chemoradiotherapy. Conclusion： Good scanning mehtod and correct gastrointestinal preparation are the key procedures in accurate preoperative staging for rectal cacinoma on CT. The preoperative T staging of middle-late stage rectal carcinoma with pelvic SCT using positive agent enema is very useful. SCT has limitation for T staging of early rectal cacinoma.