三维腔内超声检查在直肠肿瘤经肛门内镜微创手术前分期诊断中的应用价值

Application of the three-dimensional endorectal ultrasonography in the rectal tumor staging before transanal endoscopic microsurgery

目的 探讨三维腔内超声检查在直肠肿瘤经肛门内镜微创手术（TEM）术前分期诊断中的应用价值.方法 回顾性分析2012年4月至2013年12月南京中医药大学第三附属医院南京市中医院收治的30例行TEM直肠肿瘤患者的临床资料,患者术前均行三维腔内超声检查.以术后病理学检查结果为金标准,评估三维腔内超声诊断的准确率、灵敏度及特异度,采用κ一致性检验比较三维腔内超声检查与术后病理学检查结果之间的一致性.结果 30例患者术前三维腔内超声诊断T0期25例,T1期3例,T2期2例.术后病理学诊断炎性息肉（pT0期）2例,管状腺瘤（pT0期）6例,绒毛管状腺瘤（pT0期）16例,原位癌（pTis期）2例,pT1期直肠癌2例,pT2期直肠癌2例.三维腔内超声检查对2例患者分期过度,1例pT0期误分为T1期,1例pT1期误分为T2期;1例患者分期不足,pT2期误分为T1期.与术后病理学检查结果比较,三维腔内超声检查对直肠肿瘤分期诊断准确率为90.0％.其中对pT0期、pT1期、pT2期肿瘤诊断准确率分别为96.7％、90.0％、93.3％,灵敏度分别为96.2％、50.0％、50.0％,特异度分别为100.0％、92.8％、96.4％.一致性比较,术前三维腔内超声检查与术后病理学检查一致性好,差异有统计学意义（κ=0.685,P＜0.05）.结论 三维腔内超声检查对直肠肿瘤术前分期诊断准确率较高,可以为TEM提供可靠的术前评估依据.

Objective To investigate the value of the three-dimensional endorectal ultrasonography （3D-ERUS） in the tumor staging before transanal endoscopic microsurgery （TEM）.Methods The clinical data of 30 patients with rectal cancer who underwent 3D-ERUS before TEM at the Nanjing Hospital of Traditional Chinese Medicine from April 2012 to December 2013 were retrospectively analyzed.The accuracy,sensitivity and specificity of the 3D-ERUS were evaluated according to the results of the postoperative pathological examination.The consistency of the results of the 3D-ERUS and postoperative pathological examination were compared by Kappa consistency test.Results Of 30 patients,25 patients in stage T0,3 in stage T1 and 2 in stage T2 were diagnosed by preoperative 3D-ERUS.There were 2 patients （stage pT0） with inflammatory polyp by postoperative pathological diagnosis,6 patients （stage pT0） with tubular adenoma,16 patients （stage pT0） with villioustublar adenoma,2 patients （stage pTis） with carcinoma in situ,2 patients （stage pT1） with tectal adenoma and 2 patients （stage pT2） with rectal adenoma.There were 2 patients with excessive tumor staging by 3D-ERUS,1 patient in stage pT0 was misdiagnosed in stage T1,1 in stage pT1 was misdiagnosed in stage T2 and 1 in stage pT2 was misdiagnosed in stage T1 with insufficient tumor staging.The accuracy of 3D-ERUS in the preoperative tumors staging of TEM was 90.0% compared with the resuls of postoperative pathological examination.The accuracy,sensitivity and specificity of 3D-ERUS in stage pT0,pTl,and pT2 of TEM were 96.7%,90.0%,93.3% and 96.2%,50.0%,50.0% and 100.0%,92.8%,96.4%,respectively.There was a significant difference in the consistency between preoperative 3D-ERUS and postoperative pathological examination （κ =0.685,P 〈 0.05）.Conclusion 3D-ERUS is an accurate clinical method in the preoperative tumors staging of TEM,and can be used as the preoperative assessment for TEM.