结直肠癌侵犯深度和周围淋巴结转移的内镜超声诊断(附60例报告)

ENDOSCOPIC ULTRASONOGRAPHY IN THE DIAGNOSIS OF COLORECTAL CARCINOMA INVASION AND LYMPH NODE METASTASIS (60 CASES REPORT)

目的 :探讨内镜超声 (endoscopicultrasonography ,EUS)在结直肠癌侵犯深度和周围淋巴结转移术前诊断中的应用价值。方法 :对 6 0例手术切除的结直肠癌患者术前行内镜超声检查 ,所有病例术后均得到病理证实。经EUS检查发现正常结直肠壁表现为 5层结构 ,第 1,3,5层表现为回声 ,第 2 ,4层表现为低回声。第 1,2层为粘膜层 ,第 3层为粘膜下层 ,第 4层为固有肌层 ,第 5层为浆膜下和浆膜层。EUS下结直肠癌表现为低回声肿块 ,其回声强度介于第 3层高回声和第 4层低回声之间。根据EUS下结直肠壁 5层结构和邻近器官的改变判断肿瘤侵犯的深度。肿瘤旁直径≥ 5mm圆形的低回声病灶诊断为转移性淋巴结。结果 :EUS对结直肠癌侵犯深度诊断总的准确率为 85 % ,周围淋巴结转移诊断的敏感性和特异性为 5 4.8%和 6 6 .7%。结论 :EUS对结直肠癌侵犯深度的诊断有很高的准确率 ,对结直肠癌术前TNM或Dukes分期有一定价值。

Objective:To assess the value of endoscopic ultrasonography (EUS) in the pre-operative diagnosis of colorectal carcinoma.invasion and lymph node metastasis.Method:60 patients with colorectal carcinoma proven pathologically after surgical resection were given EUS before operation from Jan,2001 to June,2001.Normal colorectal wall was visualized by EUS as a five-layered sturcture.The first,third and fifth layers were hyperechoic,the second and fourth layers were hypoechoic.The first and second layers comprised the mucosa,the third layer the submucosa,the fourth layeer the muscularis propria,and the fifth layer the subserosa and serosa (adventitia).Colorectal carcinoma appeared as a hypoechoic mass with an intermediate echo level between the third hyperechoic and the fourth hypoechoic layers.the depth of the tumor invasion was based on the changes of these layer sturcture and adjacent organs.Metasatic lymph node was defined as pericolonic,hypoechoic mass lesion with a size≥5mm in diameter.Results:EUS had an overall accuracy rate of 85% in the diagnosis of the depth of colorectal cancer.The sensitivity and specificity of EUS in the diagnosis of lymph node metastasis were 54.8% and 66.7%.Conclusions:EUS has a high accuracy in determining the depth of colorecta carcinoma invasion and has some value in the pre-operative staging.The pre-operative EUS may provide much information and influence the choice of therapy.