经直肠腔内超声在中低位直肠癌术前分期及保肛手术中的临床价值

Clinical Value of Endorectal Ultrasonography in Preoperative Staging and Sphincter-preserving Surgery of Middle and Low Rectal Cancer

目的探讨经直肠腔内超声(endorectal ultrasonography,ERUS)术前评估中低位直肠癌的TN分期及手术是否保肛的临床价值。方法收集2015年1月~2023年1月内蒙古自治区人民医院收治的178例中低位直肠癌患者,术前均接受ERUS检查,采用χ^(2)检验分别比较ERUS影像特征、临床病理特征与中低位直肠癌患者手术是否保肛的差异;以术后病理为金标准,分析ERUS术前评估中低位直肠癌TN分期的准确率;以临床手术术式为标准,分析ERUS在术前评估中低位直肠癌手术是否保肛的准确率。结果病理T分期、病理分化程度、肿瘤的浸润深度、肿瘤下缘距肛缘的距离、超声T分期在中低位直肠癌手术方案的选择中比较,差异有统计学意义(P<0.05)。与实际病理结果比较,ERUS术前评估中低位直肠癌T分期具有高度一致性(Kappa=0.730,P<0.001),ERUS术前评估N分期具有中等一致性(Kappa=0.524,P<0.001)。与实际手术术式比较,ERUS术前评估手术方案具有高度一致性(Kappa=0.676,P<0.001)。结论ERUS术前评估中低位直肠癌TN分期具较高准确率,术前评估手术是否保肛与临床具有高度一致性,可为临床提供参考。

Objective To explore the clinical value of preoperative TN staging and sphincter-preserving of middle and low rectal cancer by endorectal ultrasonography(ERUS).Methods A total of 178 patients with middle and low rectal cancer admitted to the People′s Hospital of Inner Mongolia Autonomous Region from January 2015 to January 2023 underwent ERUS examination before surgery.χ^(2) test was used to compare the imaging features of ERUS,clinicopathological features and sphincter-preserving in patients with middle and low rectal cancer.Using postoperative pathology as the gold standard,the accuracy of ERUS in preoperative evaluation of TN staging of middle and low rectal cancer was analyzed.Using clinical operation as the standard,the accuracy of ERUS in preoperative evaluation of sphincter-preserving for middle and low rectal cancer was analyzed.Results Pathological T stage,pathological differentiation degree,infiltration depth of tumor,distance of lower tumor margin from anal margin and ultrasonic T stage had statistical significance in the selection of surgical program for middle and low rectal cancer(P<0.05).Compared with the actual pathological results,the T stage of middle and low rectal cancer assessed by ERUS before surgery was highly consistent(Kappa=0.730,P<0.001),and the N stage assessed by ERUS before surgery was moderately consistent(Kappa=0.524,P<0.001).Compared with the actual surgical procedure,the preoperative surgical protocol assessed by ERUS before surgery was highly consistent(Kappa=0.676,P<0.001).Conclusion ERUS examination has high accuracy in preoperative TN staging assessment of middle and low rectal cancer,and preoperative assessment of sphincter-preserving is highly consistent with clinical practice,which can be used as a clinical reference.