16排螺旋CT对直肠癌术前诊断及分期的评估与手术方案选择的研究

16-Slice Spiral CT in Preoperative Diagnosis and Staging Assessment of Rectal Cancer and Surgical Scheme Se- lecting

为探讨16排螺旋CT对直肠癌术前诊断、分期的评估及手术治疗方案选择的参考价值，选取直肠癌60例，术前采用16排螺旋CT扫描检查，并根据其检查结果，与其诊断将分期进行评估，最后和其病理分期与手术方案进行对比分析。结果显示，以术后病理学TNM分期为金标准，与术前CT-TNM诊断一致的有44例，CT-TNM分期诊断的准确率为73．33％。两者具有高度一致性（Kappa值为0．669，P〈O．05）。对影响手术方案选择的因素进行单因素分析，肿瘤下缘与齿状线的距离（F=3．397，P=0．031）、肿瘤的厚度（F=4．533，P=0．015），CTM分期（X^2=9．568，P=0．009）以及CT-TNM分期（X^2=12,163，P=0．034）与手术方案的选择相关。Spearman相关性分析结果显示，肿瘤的厚度（cc=0．328，P=0．015）、CT-M分期（cc=0．358，P=0．006）以及CT-TNM分期（cc-0．354，P=0．006）与手术方案有明显的相关性，而肿瘤下缘与齿状线的距离（cc-0．082，P=0．536）与手术方案无明显相关性。结果表明，通过16排螺旋CT检查，在术前对肿瘤的厚度、CTM分期以及CT-TNM分期进行评估，能够给手术方案的选择提供重要的参考。

This study was to discuss the value of 16 -slice spiral CT in preoperative diagnosis and staging assessment of rectal cancer, as well surgical scheme selecting. Sixty cases of rectal cancer underwent the scanning of 16-slice spiral CT preoperatively for its diagnosis and staging. The results of the pathological stages and surgical scheme were compared and analyzed. The results showed that considering postoperative pathological TNM staging as the gold standard,there were 44 cases whose pathological stages were in ac- cordance with preoperative TNM staging with CT,the rate of diagnostic accuracy with CT was 73.33%; there was a high degree of consistency between them（Kappa= 0. 669, P〈0.05）. Univariate analysis was conducted on the factors affecting surgical scheme selecting, which showed that the distance between the lower edge of tumor and the dental line（ F =3. 397, P =0. 031） ,and the thickness of tumor（ F =4. 533, P =0. 015）,M staging with CT（X^2=9. 568, P =0. 009）,TNM staging with CT （X^2=12. 163, P =0. 034） were correlated to surgical scheme. Spearman correlation analysis showed that the thickness of tumor （cc= 0. 328, P =0. 015）,M staging with CT（cc=0. 358, P =0. 006）,TNM staging with CT（cc=0. 354, P = 0. 006） were significantly correlated to surgical scheme while the distance between the lower edge of tumor and the dental line showed no correlation（cc=0. 082, P =0. 536）. It is concluded that multi-slice spiral CT examination can be used for preoperative assessment of the thickness of tumor,M staging and TNM stag- ing with CT,so as to provide an important reference to surgical scheme.