经直肠超声在直肠癌治疗决策中的应用价值及进展

Value and progress of endorectal ultrasound in the treatment decision of rectal cancer

直肠癌是我国第五大常见的恶性肿瘤,病死率也高居第5位,近年来由于饮食习惯改变等因素发病率仍有上升。由于治疗方法的多样化,直肠癌术前准确的TNM分期对于临床制定最佳治疗方案及预后判断尤为关键。经直肠腔内超声(ERUS)是目前公认为术前评估肿瘤分期的一种快速、安全而准确的首选影像学方法。ERUS诊断直肠癌浸润深度和术后复发的准确性及敏感度均高于CT,而与MRI相当,已被临床广泛应用于辅助制定直肠癌患者的治疗方案;但对于淋巴结转移的评估准确性仍较低。近年来发展的超声新技术如超声造影、超声弹性成像及三维超声有望提高直肠癌术前分期的准确性并减少分期过高或过低的问题,具有潜在的临床应用价值。

Rectal cancer is the fifth most common malignant tumor in China, and the mortality rate is also the fifth highest. In recent years, the incidence of rectal cancer is still rising due to changes in dietary habits. Because of the variety of treatment strategies, accurate preoperative TNM staging of rectal cancer is the key to the best clinical treatment and prognosis assessment. Endorectal ultrasound （ERUS） is a fast, safe and accurate imaging method for preoperative evaluation of tumor staging for rectal cancer. For the detection of the depth of tumor invasion and recurrence of rectal cancer after operation, the diagnostic accuracy of ERUS was higher than CT, and is equivalent to MRI. ERUS has been widely used in clinical treatment decision for patients with rectal cancer. However, the diagnostic accuracy of lymph node metastasis is still low. The new ultrasound technologies, such as contrast-enhanced ultrasound, ultrasound elastography and three-dimensional ultrasonography, are expected to improve the preoperative staging of rectal cancer, and have potential values in clinical application.