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直肠腔内超声在直肠癌术前环周切缘评估中的作用

仲光熙,  张璟,  戴晴,  李建初,  姜玉新

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文章导航 > 协和医学杂志  > 2015 >  6(2): 128-132
仲光熙, 张璟, 戴晴, 李建初, 姜玉新. 直肠腔内超声在直肠癌术前环周切缘评估中的作用[J]. 协和医学杂志, 2015, 6(2): 128-132. doi: 10.3969/j.issn.1674-9081.2015.02.011
引用本文: 仲光熙, 张璟, 戴晴, 李建初, 姜玉新. 直肠腔内超声在直肠癌术前环周切缘评估中的作用[J]. 协和医学杂志, 2015, 6(2): 128-132. doi: 10.3969/j.issn.1674-9081.2015.02.011
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Guang-xi ZHONG, Jing ZHANG, Qing DAI, Jian-chu LI, Yu-xin JIANG. Value of Endorectal Ultrasound in Preoperative Prediction of Circumferential Resection Margin of Rectal Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2015, 6(2): 128-132. doi: 10.3969/j.issn.1674-9081.2015.02.011
Citation: Guang-xi ZHONG, Jing ZHANG, Qing DAI, Jian-chu LI, Yu-xin JIANG. Value of Endorectal Ultrasound in Preoperative Prediction of Circumferential Resection Margin of Rectal Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2015, 6(2): 128-132. doi: 10.3969/j.issn.1674-9081.2015.02.011
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直肠腔内超声在直肠癌术前环周切缘评估中的作用

doi: 10.3969/j.issn.1674-9081.2015.02.011

  • 中国医学科学院 北京协和医学院 北京协和医院超声医学科, 北京 100730

详细信息
    通讯作者:

    姜玉新 电话:010-69155491, E-mail:jiangyuxinxh@163.com

  • 中图分类号: R735.3+7;R445.1

Value of Endorectal Ultrasound in Preoperative Prediction of Circumferential Resection Margin of Rectal Cancer

  • Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要:   目的  评估直肠腔内超声(endorectal ultrasound, ERUS)诊断直肠癌环周切缘(circumferential resection margin, CRM)的可行性和准确性  目的  回顾性分析2010年5月至2013年12月在北京协和医院行术前ERUS评估的直肠癌患者120例。纳入患者仅采用直肠全系膜切除术切除肿瘤, 未采用术前新辅助放化疗治疗。患者行术前ERUS检查时测量CRM, 即肿瘤的最外缘与直肠系膜筋膜的最短距离。以病理结果为金标准, 比较不同CRM诊断标准下ERUS的诊断价值。分析ERUS对不同位置、距肛缘距离、分期的CRM诊断准确性差异  结果  ERUS可以显示直肠系膜筋膜114例, 显示率为95%。采用不同探头频率, 直肠系膜筋膜显示的差异存在统计学意义(P=0.034)。以CRM ≤ 2 mm为标准时, ERUS诊断CRM的敏感性、准确性、阴性预测值最高, 分别为100%、98.2%、100%。ERUS对不同位置、距肛缘距离、病理分期病灶的诊断准确性差异不具有统计学意义(P>0.05)  结论  ERUS可以准确诊断直肠癌环周切缘, 同时具有较高的阴性预测值, 可为判断预后及制定临床治疗方案提供可靠依据。
    Abstract:   Objective  To evaluate the feasibility and accuracy of endorectal ultrasound (ERUS) in predicting the circumferential resection margin (CRM) of rectal cancer.  Methods  Between May 2010 and December 2013, 120 patients with rectal cancer preoperatively evaluated with ERUS in Peking Union Medical College Hospital were retrospectively analyzed. The patients underwent total mesorectal excision without neoadjuvant chemoradiotherapy. CRM was measured with preoperative ERUS, i.e. the shortest distance between the outer edge of tumor and the mesorectal fascia. With pathological results as gold standard, the diagnostic values of ERUS under different criteria for CRM were assessed. The diagnostic accuracies of ERUS in predicting CRM among different positions, distances from the anal verge, and stages were analyzed.  Results  ERUS showed mesorectal fascia in 114 cases (95%). The display rates of mesorectal fascia by ERUS with different transducer frequencies were significantly different (P=0.034). With CRM ≤ 2 mm as the standard, the sensitivity, accuracy and negative predictive value of ERUS in predicting CRM were the highest (100%, 98.2%, 100%). The diagnostic accuracies of ERUS among different positions, distances from the anal verge, and stages were not significantly different (P>0.05).  Conclusion  ERUS can accurately predict CRM, with a high negative predictive value, which can provide reliable information for assessment of prognosis and formulation of clinical treatment plan.
    • HTML全文

  • 图  1  男性正常直肠系膜直肠腔内超声图，箭头示直肠系膜筋膜

    下载: 全尺寸图片 幻灯片

    图  2  前壁T3期直肠癌直肠腔内超声图，箭头示直肠前壁系膜筋膜，短线代表肿瘤的最外缘与直肠系膜筋膜的最短距离，即环周切缘

    下载: 全尺寸图片 幻灯片

    表  1  120例直肠癌病灶的基本情况

    项目 例(%)
    位置  
      前 24(20.0)
      后 31(25.8)
      左 27(22.5)
      右 36(30.0)
      环肠一周 2(1.7)
    病灶距肛缘距离  
      下段(≤6 cm) 44(36.7)
      中段(7~10 cm) 76(63.3)
    pT和pN分期  
      pT1 12(10.0)
      pT2 44(36.7)
      pT3 63(52.5)
      pT4 1(0.8)
      pN0 72(60.0)
      pN1 43(35.8)
      pN2 5(4.2)
    病理CRM  
      阴性 114(95.0)
      阳性 6(5.0)
    CRM:直肠癌环周切缘
    下载: 导出CSV

    表  2  影响MRF显示的因素比较

    因素 MRF可显示
    (n=114)    		 MRF未显示
    (n=6)    		 χ2值 P值
    探头频率     4.511 0.034
      5~7 MHz 50 0    
      9~10 MHz 64 6    
    扩张肠腔     0.067 0.796
      肠腔注水 44 2    
    探头水囊 70 4    
    MRF：直肠系膜筋膜
    下载: 导出CSV

    表  3  不同CRM诊断标准下ERUS的诊断价值

    CRM诊断标准 敏感性 特异性 准确性 阳性预测值 阴性预测值
    ≤1 mm 50 100 97.3 100 97.2
    ≤2 mm 100 98.1 98.2 75 100
    ≤3 mm 100 96.2 96.4 60 100
    CRM：同表 1；ERUS：直肠腔内超声
    下载: 导出CSV

    表  4  不同位置、距肛缘距离、分期的CRM诊断准确性比较

    因素 CRM可显示
    (n=112)    		 CRM未显示
    (n=2)    		 P值
    距肛缘距离     0.067
      下段(≤6 cm) 41 2  
      中段(7~10 cm) 71 0  
    位置*     0.058
      右 33 1  
      左 25 1  
      前 22 0  
      后 30 0  
    pT分期     0.940
      pT1+pT2 53 1  
      pT3+pT4 59 1  
    pN分期     0.759
      N0 68 1  
      N1+N2 44 1  
    CRM:同表 1；*2例环肠一周的病例被排除
    下载: 导出CSV
    • 参考文献(17)
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  • 收稿日期:  2014-12-23
  • 刊出日期:  2015-03-30

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