术前磁共振分期联合腹腔镜外科治疗直肠癌临床研究

Clinical research combining preoperative magnetic resonance imaging staging with laparoscopic surgery on the therapy of rectal carcinoma

目的探讨术前磁共振(MRI)分期联合腹腔镜全直肠系膜切除治疗直肠癌临床疗效。方法 89例直肠癌患者分为实验组(n=45)及对照组(n=44),实验组均行MRI扫描术前分期,T_3期及以下者行腹腔镜全直肠系膜切除(TME)术,判定T_4期及环周切缘受累者则先行新辅助化疗,再行腹腔镜TME术。对照组则术前行CT大概评估后行开腹TME术。对照术后组织病理结果,比较术前MRI是否与术后组织病理具有一致性,比较实验组与对照组在获得淋巴结数目、切缘控制、保肛率等指标上是否存在差异。结果 T分期,术前MRI准确性为86.7%(39/45);N分期准确性为71%(32/45);环周切缘准确率为84.4%(38/45),敏感性为100%(4/4)。结论术前MRI与术后组织病理结果具有一致性,对环周切缘评价也具有较高正确性,可以作为挑选合适的新辅助化疗患者的有效方法;术前MRI分期联合腹腔镜TME术能更好地控制切缘,但保肛率无明显差异,有待样本量增多后继续观察。

Objective To explore the clinical effect of preoperative magnetic resonance imaging（MRI） staging with laparoscopic total mesorectum excision（TME） curing rectum carcinoma. Methods Eighty- nine patients with histologically proven rectal carcinoma were divided into experimental group（n = 45） and control group（n = 44）.The experimental group was staged preoperatively by MRI scan,then got the MRI stage,the specimens of T_3 and blew ones underwent laparoscopic TME.T_4 or circumferential involvement should receive neoadjuvant chemotherapy,then undergo laparoscopic TME.Meanwhile,the control group received the transabdominal TME after being assessed by CT scanning.Concordance between MRI staging of tumor,local lymph node,and CRM involvement and pathologic reporting was evaluated.The difference about lymph node number, cutting edge control and anus keeping rate between the two groups were compared.Results T stage,preoperative MRI accuracy was 86.7%（39/45）,N staging accuracy was 71%（32/45）, circumferential resection margin accuracy was 84.4%（38/45）,and sensitivity 100%（4/4）.Conclusion Preoperative MRI staging has a good concordance with pathologic outcomes,preoperative MRI could provide reliable information about staging and thus help to choose adequate patients who can benefit from neoadjuvant chemotherapy.Combining preoperative MRI staging with laparoscopic TME has better cutting edge control,but there isn＇t difference about anus keeping rate,therefore we need to observe more samples.