螺旋CT在直肠癌术前分期中临床应用价值研究

The clinical value ofslicespiral CT in the preoperative staging of colorectal cancer before

目的:探讨在直肠癌术前分期诊断中采用螺旋CT的临床应用价值,分析其临床适用性。方法:回顾性分析2015年10月至2017年5月于我院治疗的47例直肠癌患者的临床资料,所有患者均进行螺旋CT检查,检查后约3天,遵从全直肠系膜切除术的原则,对患者行手术治疗。比较直肠癌患者在进展期阶段CT与病理分期的精确性、直肠癌患者淋巴结分期各参数、直肠癌患者CRM相关的受累因素、直肠癌患者CRM和手术前CT预测的各参数及直肠癌患者行CT平扫和增强扫描各病理结果的分析。结果:T2、T3、T4三期的检测准确度比较,差异具有统计学意义(χ~2=31.9591,P=0.0000);淋巴结分期检测的总体准确度为76.60%且灵敏度为65.52%,特异度为94.44%,两组比较差异具有统计学意义(χ~2=13.9743,P=0.0002);患者和CMR受累有明显相关因素为手术治疗方式、TNM分期、Borrmann分型,而相关因素不明显的为距齿状线距离和肿瘤分化程度;术前CT预测的总体准确度为87.23%且灵敏度为76.92%,特异度为91.76%,两者比较差异具有统计学意义(χ~2=22.3331,P=0.0000);CT平扫和增强扫描对淋巴结分期无明显影响(χ~2=0.0038,P=0.9505)、对诊断肿瘤系膜侵犯无明显差异(χ~2=0.0689,P=0.7929);对诊断肿瘤侵犯邻近器官结构无明显差异(χ~2=0.1389,P=0.7094)。结论:直肠癌术前分期诊断中采用螺旋CT检查,能够取得较好的临床诊断效果,值得在临床上进行推广与应用。

Objective To investigate the preoperative staging of colorectal cancer before the clinical value of spiral CT in the diagnosis, analysis of its clinical applicability. Methods A retrospective analysis from October 2015to May 2017I clinical data in 47 cases of colorectal cancer in patients with hospital treatment, all patients underwent spiral CT, about three days after the inspection, comply with TME surgery principles for patients treated surgically. Comparison of colorectal cancer patients in advanced stages of the accuracy of CT and pathologic stage, lymph node staging in patients with colorectal cancer each parameter, colorectal cancer patient involvement CRM-related factors, patients with colorectal cancer CRM and various parameters and underwent pre-operative CT predict colorectal cancer plain and enhanced CT scans and pathological analysis of the results. Results T2, T3, T4 three of detection accuracy, the difference was statistically significant （χ2= 31.9591, P=0.0000）; the overall accuracy of lymph node staging was 76.60% and the detection sensitivity of 65.52% and a specificity of 94.44 %, the difference was statistically significant （χ2= 13.9743, P=0.0002）; CMR involvement of patients and significantly correlated factors surgical treatment, TNM stage, Borrmann type, and related factors inconspicuous the distance from the dentate line and tumor differentiation; the overall accuracy of preoperative CT prediction of 87.23 percent and a sensitivity of 76.92% and a specificity of 91.76%, the difference was statistically significant （χ2= 22.3331, P= 0.0000）; CT plain and enhanced scanning stage had no significant effect on lymph node （χ2= 0.0038, P=0.9505）, no significant difference in the diagnosis of tumor mesangial violations （χ2=0.0689, P=0.7929）; the diagnosis tumor invasion of adjacent organs structure was no significant difference（χ2= 0.1389, P=0.7094）. Conclusion The diagnosis of colorectal cancer staging using spiral CT examination, can achieve better clinical diagnosis effect, worthy of promotion and application in clinical practice.