经直肠超声术前评估直肠癌累及直肠系膜筋膜

Endorectal ultrasound in evaluation on mesorectal fascia invasion in preoperative rectal cancer

目的探讨经直肠超声(ERUS)术前评估直肠癌累及直肠系膜筋膜(MRF)的价值。方法 44例直肠癌患者术前均接受ERUS检查,其中18例接受新辅助放化疗,26例未接受;所有患者于接受ERUS检查后1周内行全直肠系膜切除手术(TME)。以术后病理诊断环周切缘(CRM)的结果为金标准,判断ERUS术前评估直肠癌累及MRF的诊断效能。结果 44例患者中,术后病理诊断T1期2例,T2期17例,T3期25例;CRM阳性2例,CRM阴性42例。低位直肠癌16例,中位直肠癌28例。肿瘤位于前壁和前侧壁26例,后壁和后侧壁13例,累及肠壁全周5例。ERUS对术前接受和未接受新辅助放化疗的患者诊断准确率分别为83.33%(15/18)和92.31%(24/26);肿物位于前壁和前侧壁时,诊断准确率为80.77%(21/26),而肿物位于后壁和后侧壁时为100%(13/13);对于低位和中位直肠癌,诊断准确率分别为75.00%(12/16)和96.43%(27/28);总准确率为88.64%(39/44)。结论 ERUS是术前评估直肠癌是否累及MRF的有效辅助检查方法。

Objective To evaluate the value of endorectal ultrasonography（ERUS）in assessment of mesorectal fascia（MRF）invasion in rectal cancer.Methods Data of 44 patients who accepted preoperative ERUS and total mesorectal excision surgery within a week were retrospective analyzed.There were 18 patients who accepted preoperative neoadjuvant chemotherapy and 26 patients didn＇t acceped.Taking the pathological diagnosis of circumferential resection margin（CRM）as the ＂gold standard＂,the diagnostic efficiency of ERUS for the MRF invasion in rectal cancer was evaluated.ResultsThe final pathological T staging was T1 in 2cases,T2 in 17cases and T3 in 25cases.There were 2cases of CRM positive results,and 42 cases of CRM negative results.With regard to the location of tumor,there were 16 cases located in low,and 28 cases in mid rectum.There were 26 cases located in anterior or antero-lateral wall of rectum,13 cases in posterior or postero-lateral wall,and 5cases with a circle of rectum.The diagnostic accuracy were 83.33%（15/18）and 92.31%（24/26）for cases of accepting and not accepting the preoperative neoadjuvant chemotherapy;80.77%（21/26）for cases located in anterior or antero-lateral wall,and 100%（13/13）for cases located in posterior or postero-lateral wall;75.00%（12/16）and 96.43%（27/28）for low position and mid position tumors.The total diagnostic accuracy was 88.64%（39/44）.Conclusion ERUS can be an effective method in preoperative assessment of the MRF invasion in rectal cancer.