经直肠超声诊断直肠类癌及辅助TEM手术的价值分析

Analysis of the value of transrectal ultrasonography in the diagnosis of rectal carcinoid and assisting TEM

目的:探讨经直肠超声(transrectal ultrasonography,TRUS)对直肠类癌的诊断及辅助经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)的价值。方法:选取2015年1月—2016年12月入该院诊治并获得明确病理结果的直肠隆起性病变患者65例,所有患者术前均接受了结肠镜、TRUS和小探头超声内镜(miniprobe sonography,MPS)检查。总结直肠类癌的经直肠超声影像学特征,并比较结肠镜、TRUS、MPS对直肠类癌的诊断准确率。应用TRUS对上述类癌患者行TEM术前定位、术后并发症筛查和随访。结果:直肠类癌的TRUS影像学特征表现为黏膜下层的类圆形、低回声、富血供结节,边清,内部回声均匀;TRUS对直肠类癌有较高的诊断准确率(96.9%),与MPS(95.4%)比较差异无统计学意义(P>0.05),优于结肠镜(81.5%)(P<0.05)。TRUS对直肠类癌TEM的术前定位、术后并发症的发现和随访有重要应用价值。结论:TRUS对直肠类癌具有较高的诊断价值,可媲美MPS,可作为辅助TEM手术的首选影像学检查方法。

Objective： To explore the value of transrectal ultrasonography （TRUS） in the diagnosis of rectal carcinoid and assisted transanal endoscopic microsurgery （TEM）. Methods： Between January 2015 and December 2016, the data of 65 patients with rectal protuberant lesions were collected. Miniprobe sonography （MPS）, colonoscopy, TRUS and pathologic examinations were performed. The TRUS images of rectal carcinoid confirmed by pathology were analyzed to find out the characteristics. The accuracies of colonoscopy, TRUS and MPS in diagnosing rectal carcinoid were compared. TRUS was applied to localize the lesions before TEM, discover the postoperative surgical complications and follow up. Results： The TRUS characteristics of rectal carcinoid includes well-defined boundary, homogeneous echo, hypoechoic nodules with rich blood supply in the submucosa. TRUS had a high accuracy rate of 96.9% in the diagnosis of rectal carcinoid, similar with MPS （95.4%）, and superior to colonoscopy （81.5%）. TRUS was of great value in the preoperative localization of rectal carcinoid, the detection of postoperative complications and follow up. Conclusion： TRUS has a high diagnostic value for rectal carcinoid, as good as MPS, and can be used as the first-choice imaging method for TEM.