直肠下段肿瘤术前经直肠腔内超声评估与手术对比研究

Comparative Study of Preoperative Assessment by Transrectal Ultrasonography and Operative Procedure in Lower Rectal Tumors

通过对直肠下段肿瘤术前经直肠腔内超声评估与外科手术对照 ,评价经直肠腔内超声 (TRU S)对直肠癌分期的准确性及对直肠下段肿瘤手术方案选择的价值。对拟诊为直肠下段肿瘤 (肿瘤距肛缘≤ 8cm)的患者共 5 2例进行了 TRU S检查 ,其中直肠癌 48例 ,直肠癌复发 2例 ,侵犯直肠的盆腔转移癌 2例。 48例直肠癌中 ,超声分期 (u T)与病理分期 (p T)符合 43例 ,符合率为 85 .4%。 2 2例超声诊断有淋巴结转移 ,经手术、病理证实 13例 ,另 2例术前未发现。超声诊断淋巴结转移的特异性为 5 9.1%,敏感性为 86 .7%。提示 :TRUS对直肠下段肿瘤是一种准确、可靠的诊断方法 ,能为临床医师选择合适的手术方案提供有价值的信息。

The accuracy and clinical usefulness of transrectal ultrasonography(TRUS) in preoperative staging of rectal carcinoma and the value of TRUS for selecting operative procedure in lower rectal tumors were assessed. Between April 1999 and April 2000, 52 patients with lower rectal tumors were examined with TRUS. Among them, 48 patients were with rectal cancer, 2 with recurrent cancer, 2 with pelvic metastatic tumors infiltrating rectal wall .No patients were found having metastasis in liver or lung preoperatively; Fouty-eight patients with rectal cancer were staged by TRUS: 5 as Ut1, 11 as Ut2, 24 as Ut3, 8 as Ut4. The overall staging accuracy for all 48 patients was 85.4%, 5 tumor were overstaged and 2 understaged. Thirteen out of 22 patients who were diagnosed as having node metastasis by TRUS were confirmed by histopathology and 2 patients with lymph node metastasis were not found by TRUS. The specificity were 59.1% and sensitivity 86.7%. It was suggested that TRUS is a precise and reliable diagnostic tool for lower rectal tumors and can provide useful information for clinicians in making diagnosis and selecting suitable operative procedure.