直肠腔内超声联合癌胚抗原对直肠癌术前分期

The combination of transrectal ultrasonography and serum CEA in preoperative staging of rectal carcinoma

目的 研究直肠腔内超声单独及联合癌胚抗原对直肠癌术前浸润深度（T分期）、局部淋巴结转移（N分期）的准确性.方法 回顾性分析2007年1月年2010年1月山西省肿瘤医院收治的310例直肠癌患者临床资料,术前均行直肠腔内超声及血清癌胚抗原检测.癌胚抗原阳性标准为＞5 μg/L,对比超声分期与术后病理分期结果,计算直肠腔内超声单独及联合癌胚抗原对T分期和N分期的准确性.结果 各病理分期患者术前血清癌胚抗原水平差异有统计学意义（P＜0.05）.直肠腔内超声对直肠癌术前T分期的诊断准确率为71％（219/310）,联合血清癌胚抗原可使T分期诊断准确率达82％（254/310）,差异有统计学意义（x2=10.92,P＜ 0.01）.直肠腔内超声对直肠癌术前N分期诊断准确率为69 ％（211/308）,联合血清癌胚抗原可使N分期诊断准确率达77％（238/308）,差异有统计学意义（x2=5.00,P＜ 0.05）.结论 术前血清癌胚抗原水平随病理分期的增加而增高.直肠腔内超声联合血清癌胚抗原有助于提高直肠癌术前分期的准确性.

Objective To evaluate the diagnostic accuracy of the combination of endorectal ultrasonography and serum CEA in preoperative diagnosis of rectal wall invasion （T staging） and nodal involvement （N staging） of rectal carcinoma.Methods We retrospectively analyzed clinical records of 310 patients with rectal carcinoma who underwent endorectal ultrasonography and serum CEA evaluation in Shanxi Province Tumor hospital from January 2007 to January 2010.The positive standard of CEA is more than 5 μg/L.The endorectal ultrasonography staging with postoperative pathological staging,and calculated the overall accuracy of T staging and N staging based on TRUS alone or on TRUS combined with serum CEA level were compared.Results The difference in serum CEA level was statistically significant from T1 to T4 （P 〈 0.05）.The accuracy rate of preoperative T staging of rectal carcinoma by TRUS alone was 71% （219/310） and was 82 % （254/310） with TRUS combined with serum CEA level,showing significant statistical difference （x2 =10.92,P 〈 0.01）.The accuracy rate of preoperative N staging of rectal carcinoma was 69 % （211/308）with TRUS alone and was 77 % （238/308） with TRUS combined with serum CEA level,the difference of which was statistically significant （x2 =5.00,P 〈 0.05）.Conclusion Serum CEA level increases with an increasing pathological stage of rectal cancer.The combination of TRUS and serum CEA improves the accuracy of preoperative staging of rectal cancer.