腔内超声对确定直肠癌边界及远端手术切缘的临床意义

Clinical significance of transrectal ultrasound in detecting of rectal cancer margin and deciding of distal surgical incisal edge

目的 探讨腔内超声对确定直肠癌病灶边界及直肠远端手术切缘的意义。方法 应用高频腔内超声探头 ,对 33例直肠癌标本在腔内超声引导下确定直肠远端切缘 ,与病理组织学结果对照。用聚合酶链反应 单链构象多态性分析 (polymerasechainreation singlestrandconformationpolymorphism ,PCR SSCP)方法 ,以p5 3、K ras基因突变作为肿瘤分子标志物 ,检测切缘残余癌细胞。结果 33例腔内超声探测结果 ,对直肠癌浸润深度判断的准确性为 86 6 % ,其中对黏膜、黏膜下浸润病变的准确性为 72 7% ,对肌层浸润的准确性为 90 9% ,对外膜、直肠周围组织受侵的准确性分别为88 5 %、10 0 %。在腔内超声确定病灶边界远端肠段 1 0、2 0、3 0cm切缘病理组织学检查均未见残留癌细胞 ,PCR SSCP未检测到残留癌细胞突变基因分子标志。结论 腔内超声对直肠癌病灶边界的显示与病理组织学检查结果更为接近 ,经直肠腔内超声对术中确定直肠远端切缘较为准确、安全。

Objective To study the role of transrectal ultrasound in detecting and deciding rectal cancer margin and surgical incisal edge . Methods 33 surgical specimens of rectal carcinoma were examined with transrectal ultrasound. Cancerous margin and surgical incisal edge were determined. The results were compared with pathological examination. p53 and K-ras gene mutation as tumor molecular markers of residue cancer cells were detected in incisal edge tissue with PCR-SSCP method. Results General accuracy for cancer infiltration depth with transrectal ultrasound was 86.6%. For mucosa and submucosa infiltration lesions,the accuracy was 72.7%. For lamina muscularis,the accuracy was 90.9%. And for adventitia and peripheral tissue infiltration of rectum,the accuracy was 88.5% and 100% respectively. No remains of cancer cells and tumor molecular markers were detected at distal incisal edges of 1.0 cm,2.0 cm and 3.0cm determined with transrectal ultrasound. Conclusions Rectal cancer margine and surgical incisal edge determined with transrectal ultrasound are close to examined by pathology. Transrectal ultrasoun is helpful and reliable to define incisal edge in rectal cancer surgery.