直肠指检对中低位直肠癌术前评估意义的临床分析

Clinical significance of digital rectal examination for preoperative assessment in mid-low rectal cancers

目的探讨直肠指检在直肠癌术前评估中的临床意义。方法前瞻性纳入132例中低位直肠癌患者行直肠指检,判断肿瘤下缘距肛缘距离、浸润肠壁周径长度、大体类型及浸润深度指标,分析上述指标与术后病理判断的准确率以及与淋巴结转移率的关系。结果直肠指检对中低位直肠癌肿瘤下缘距肛缘距离3~8cm准确率为63.63%~94.12%;对环周度判断准确率为82.86%~88.00%;大体类型准确率为80.00%~88.45%;对浸润深度判断准确率为75.00%~86.27%。单因素分析显示,淋巴结转移率与环周度、大体类型及浸润深度均有相关性。多因素分析显示,大体类型及浸润深度是影响淋巴结转移的独立因素。结论直肠指检对中低位直肠癌术前评估具有重要临床意义。

【Objective】To assess the value of the digital examination for mid-low rectal cancer before operation. 【Methods】132 patients diagnosed as rectal cancer were prospectively enrolled into this study. All patients were performed digital examination to assess the distance from tumor＇s inferior border to anal, the infiltration depth, the macroscopic pathology and the circulus degree. Then the results were compared with the pathologic assessing and the lymph node positive rate. 【Results】Digital examination had an excellent accuracy rate for the distance from mid-low rectal cancer＇s（3~8 cm） inferior border to anal（63.63%~94.12%）, circulus（82.86%~88.00%）, macroscopic pathology（80.00%~88.45%） and the infiltration depth（75.00%~86.27%）, respectively. Univariate analysis demon- strated that the circulus, macroscopic pathology and the infiltration depth influenced the lymph node positive rate. Cox proportional hazard model demonstrated macroscopic pathology and the infiltration depth were independent lymph node metastasis factors【.Conclusion】Digital examination for mid-low rectal cancer before operation has an important clinical significance.