64排多层螺旋CT和纤维蛋白原联合评估结肠癌对手术方案选择的影响

Choice of surgical procedures based on combined assessment of 64 multi-slice spiral computer tomography and fibrinogen levels in treatment of colon cancer

目的探讨64排多层螺旋CT(MSCT)和纤维蛋白原(FIB)联合术前评估结肠癌对手术方案选择的影响。方法前瞻性纳入130例结肠癌患者,随机均分为A组和B组,A组术前行MSCT和FIB联合评估,B组只进行MSCT评估,将术前分期和预测手术方案分别与术后病理分期和实际手术方案比较。结果实际纳入病例120例,A组60例,B组60例。2组基线情况一致。A组术前T、N、M及TNM分期的准确度分别为76.7%、78.3%、98.3%和78.3%;B组术前分别为76.7%、56.7%、96.7%和58.3%。2组在N、TNM分期之间的差异有统计学意义。A组手术预测符合率为98.3%,B组为80.0%,2组差异具有统计学意义(P=0.001)。结论 MSCT和FIB联合评估结肠癌患者的策略可以提高术前分期的准确性的同时显著提高手术预测方案的符合率。

Objective To apply combined preoperative assessment of 64 multi-slice spiral computer tomography（MSCT） and fibrinogen（FIB） in selection of surgical procedures in treatment of colon cancer.Methods One hundred and thirty patients diagnosed as colon cancer were randomly assigned into Group A and Group B.Both MSCT and FIB assessment was performed for preoperative evaluation in Group A,while only MSCT was performed in Group B.The preoperative staging and choice of operative procedures were compared with postoperative pathologic staging and operative procedures implemented,respectively.Results One hundred and twenty patients completed the study,including 60 in Group A and 60 in Group B.The baseline characteristics of two groups were statistically identical.For Group A,the accuracies of preoperative staging T,N,M and TNM were 76.7%,78.3%,98.3% and 78.3%,respectively.For Group B,the corresponding rates were 76.7%,56.7%,96.7% and 58.3%,respectively.The differences in accuracies on staging N and TNM between two groups were statistically significant.There was also a statistically significant difference in the accuracy of prediction of operative procedures between two groups（98.3% vs 80.0%,P=0.001）.Conclusion The strategy of the combined assessment of MSCT and FIB can elevate the accuracy of preoperative staging and prediction of surgery procedures in treatment of colon cancer.