直肠癌术前64排螺旋CT评估与手术方案选择

64 - slice spiral computer tomography on the preoperative assessment for the prediction to surgical procedures in rectal cancer

目的探讨直肠癌术前应用64排螺旋CT评估对于手术方案选择的指导意义。方法纳入病理确诊为直肠癌的患者188例，所有患者术前行64排螺旋CT评估，记录术前CT分期，与术后病理分期进行比较，并分析临床病理因素与手术方案选择的关系。采用Kappa值检验诊断一致性试验，相关性检验采用等级Spearman相关。结果64排螺旋CT术前评估得到CT—TNM分期准确度为75．5％，与病理TNM分期一致（Kappa值=0．641，P〈0．001）。直肠癌手术方案的选择与CT—T分期（r=0．307、P〈0．001）、CT—M分期（r=0．148，P=0．043）、CT—TNM分期（r=0．208、P=0．004）和肿瘤厚度（r=0．524、P〈0．001）具有相关性。结论64排螺旋CT行术前评估直肠癌，可以得到肿瘤厚度、CT—M分期和CT—T分期三个影响手术方案选择的客观指标，为外科医师预测直肠癌手术方案提供依据。

Objective To determine the significance of 64 - slice spiral computer tomography on the selection of operative procedures in rectal cancer. Methods Enrolled 188 patients were diagnosed definitely as rectal cancer, and received 64 - slice spiral computer tomography assessment preoperatively. The preoperative staging was compared with postoperative pathologic staging. Furthermore, the relationship between clinicopathological factors and surgical procedures was analyzed. Kappa test was used for agreement of diagnosis. The correlation test was made by Spearman rank. Results The accuracy of preoperative assessment of CT - TNM staging with 64 - slice spiral computer tomography was 75.5% （ kappa = 0. 641, P 〈 0. 001 ）. The analysis showed that CT - T staging （ r = 0. 307, P 〈 0. 001 ）, CT - M staging （ r = 0. 148, P = 0.043 ） , CT - TNM staging （ r = 0.208, P = 0. 004 ） and the tumor thickness （ r = 0. 307,P 〈 0.001 ） were correlated to the selection of operative procedures. Conclusion With the pre- operative assessment of 64 - slice spiral computer tomography in rectal cancer,we found three objective indicators including tumor thickness,CT - M staging and CT - T staging that had impact on the selection of operative procedures and provided evidence for surgeons to forecast the operative procedures in rectal cancer.