64层螺旋CT对大肠癌术前分期预测及腹腔镜手术评估的作用分析

Analysis of 64 Layer Spiral CT on Preoperative Staging Prediction and on the Role of Laparoscopic Surgery of Colorectal Cancer

目的分析研究64层螺旋CT对大肠癌术前分期预测及腹腔镜手术方案的准确性及应用价值。方法我院在2008年12月至2012年2月期间共接诊80例大肠癌患者,在术前均通过64层螺旋CT进行扫描并进行后期图像重建等技术处理,记录术前的CT-TNM分期及预计的手术方案,与术后的病理分期以及实际的手术方案作对比。结果 64层螺旋CT的诊断符合率为100%,其中CT仿真肠镜可以显示出大肠癌大体的分型,准确性为91.3%;透明显示图像(Raysum)可以较准确地显示出癌肿的范围以及长度,准确性为100%;MPR(多平面重建)可以直观准确地显示癌肿和肠周受到侵犯的程度,准确率为100%。术前评估T分期:其中对T0、T1及T4的敏感性较高,分别为100%、100%、92.3%,但对T2期的敏感性比较低,为63.6%,阳性诊断的准确率是88.2%;N分期:对N0和N3期的敏感度最高,为100%,对N2期的敏感性较低仅为50%,总体准确率为85.5%,并且当淋巴结直径>5mm时,其诊断的准确性也增高;M期:敏感度及准确率均为100%。cTNM的总准确率为79.5%,与术后病理分期保持高度一致性(κ=0.821,P=0.0)。并且64层螺旋CT在术前预测的手术方式和实际的手术方式保有较高的一致性(κ=0.314,P=0.0)。结论 64层螺旋CT能有效地显示出肠癌的部位、形态和大小,能准确地对其进行诊断及术前临床分期,准确的制定腹腔镜手术的实施方案,因此应在临床中推广应用。

Objective To analysize the accuracy and application value of64 layer spiral CT on preoperative staging prediction and laparoscopic surgery of colorectal cancer.Method There were 80 patients with colorectal cancer during January 2008 to February 2012,In preoperative,through 64 layer spiral CT scanning and image reconstruction technology of processing,record the preoperative CT-TNM staging and expected surgical plan,compare with postoperative pathologic staging and the actual operation scheme.Result Diagnostic coincidence rate of 64 layers spiral CT was 100%,CT simulation colonoscopy can show large intestine cancer general classification,the accuracy is 91.3%;Transparent display images（Raysum） can accurately show the scope of tumor and the length,the accuracy is 100%;MPR（multi planar reconstruction） can directly and accurately display of the cancer and the encroaching extent on intestinal,and the accuracy is 100%.Preoperative T stage： the sensitivities on the T0,T1 and T4 are higher（100%,100% and 92.3%）,respectively,but their sensitivity on T2stage is low（63.6%）,positive diagnosis accuracy rate is 88.2%;N staging： sensitivity on N0and N3stage are highest,at 100%,low sensitivity on the N2 is only 50%,the overall accuracy is 85.5%,and when the lymph node is greater than 5 mm in diameter,the diagnostic accuracy is also higher;M： sensitivity and accuracy were 100%.total accuracy of CTNM is 79.5%,maintain consistency with and the postoperative pathologic staging（kappa = 0.821 predominate,P=0.821）.And 64 layer spiral CT on preoperative forecast operation mode keeps high consistency with actual operation method（kappa = 0.314 predominate,P= 0.314）.Conclusion 64 layers spiral CT can effectively show the bowel cancer site,shape and size,can accurately diagnose and preoperative clinical stage,accurately work out schemes for the implementation of laparoscopic surgery,so it should be applied in clinical.