64层螺旋CT对大肠癌术前分期预测及腹腔镜手术评估的研究

64-slice spiral CT imagine technique on preoperative staging prediction and assessment of laparoscopic surgery of colorectal cancer

目的探讨64层螺旋CT(64-SCT)及其后处理技术在大肠癌术前最新国际分期中的诊断价值及手术预测评估。方法应用美国GE公司的64-SCT对74例临床确诊为大肠癌的患者进行扫描及后期图像重建,结合最新国际大肠癌分期标准,记录术前CT分期和预计手术方案,与术后病理分期和实际腹腔镜手术方案进行比较。结果 64-SCT对所有患者的诊断符合率为100%,术前评估得到对大肠癌T分期Tis、T1、T4b敏感性为100%,T2期敏感性较低(66.7%),T分期的总体准确率87.8%。N分期的敏感性以N0、N1c、N2b较高(88.1%,100%,100%),N1a、N1b、N2a敏感性较低(58.3%,60.0%,66.7%),N分期总体准确率82.4%。术前不同直径淋巴转移与术后病理结果比较显示,直径≥5mm的淋巴结CT有较高的诊断准确性(89.5%)。M分期CT具有较高的灵敏度和准确性(100%,98.6%)。cTNM总分期准确度为78.4%,与病理TNM分期高度一致(κ=0.740,P=0.000)。64-SCT术前预测手术方式与实际手术方式有较好的一致性(κ=0.936,P=0.000),能准确指导腹腔镜手术方式的选择。结论 64-SCT结合最新大肠癌国际分期,可以提高大肠癌患者术前分期的准确性及精细度,可以较好地指导术前腹腔镜大肠癌手术方式的选择,对大肠癌的术前诊断具有较高的临床应用价值。

Objective To investigate the value of the 64-slice spiral CT imagine with virtual colonoscopy on preoperative colorectal cancer staging and in surgical forecast evaluation.Methods 64-slice spiral CT from GE company was performed in 74 cases who had diagnosed as colorectal cancer to scan and to do the post-scan image reconstruction.Combining with the latest international standards for colorectal cancer staging,the postoperative surgical pathologic staging and actual surgical program were compared with each other by recording the preoperative CT staging and prediction of surgery strategy.Results The corresponding rate of diagnosis for all the patients was 100% by 64-SCT.Sensitivity of Tis,T1,T4b for T staging were all 100%,the sensitivity of T2 stage was lower（66.7%）.The overall accuracy rate of T stage was 87.8%.It indicated that the sensitivity of N0,N1c,N2b for N staging were higher which were 88,1%,100%,100% respectively and the N1a,N1b,N2a for N staging were lower（58.3%,60%,66.7%）.The overall accuracy rate of N stage was 82.4%.It showed that the accuracy rate of lymph node which diameter≥5 mm was higher（89.5%）by comparing the preoperative lymph node metastasis with different diameters with postoperative pathologic results.The sensitivity and accuracy rate for M stage were higher（100%,98.6%）.The overall accuracy rate for cTNM was 78.3% which were appreciated coincidently with pathological TNM stage（Kappa=0.74,P=0.000）.Prediction of operative procedures by 64-SCT were appreciated coincidently with actual operation methods（Kappa=0.936,P=0.000）which suggested that 64-SCT can guide the way of laparoscopic operation accurately.Conclusions 64-slice spiral CT combined with the latest international colorectal cancer stage can improve the degree of accuracy diagnosis with colorectal cancer,can guide the way of laparoscopic operation accurately and have a high value in clinical application of preoperative diagnosis of colorectal cancer.