• 1.四川大學(xué)華西臨床醫(yī)學(xué)院/華西醫(yī)院（成都 610041）;;
  • 2.四川大學(xué)華西醫(yī)院肛腸外科（成都 610041）;;
  • 3.四川大學(xué)華西醫(yī)院放射科（成都 610041）;;
  • 4.四川大學(xué)華西醫(yī)院超聲科（成都 610041）;

目的 　比較多層螺旋CT（MSCT）和經(jīng)直腸超聲（TRUS）對(duì)直腸癌患者術(shù)前分期的診斷價(jià)值。
方法 　前瞻性納入2009年1~5月期間在四川大學(xué)華西醫(yī)院肛腸外科住院的直腸癌患者，術(shù)前使用MSCT和TRUS進(jìn)行T分期和N分期，并與術(shù)后病理分期進(jìn)行比較。
結(jié)果 　本研究納入患者81例。在評(píng)估局部浸潤(rùn)方面，MSCT的準(zhǔn)確度為77.78%(63/81)，TRUS為88.89%(72/81)，差異無(wú)統(tǒng)計(jì)學(xué)意義（P=0.168）。在診斷轉(zhuǎn)移性淋巴結(jié)方面，MSCT的準(zhǔn)確度為66.67%(54/81)，TRUS為48.15%(39/81)，差異有統(tǒng)計(jì)學(xué)意義（P=0.034）。
結(jié)論 　TRUS在評(píng)估直腸癌局部浸潤(rùn)深度上更為準(zhǔn)確，但與MSCT之間的差異并不明顯。MSCT在診斷直腸癌淋巴結(jié)轉(zhuǎn)移方面比TRUS更具優(yōu)越性，但兩者的準(zhǔn)確性都還有待進(jìn)一步提高

引用本文： 陳曉婧 ,蘭凱,汪曉東,呂東昊,余敏,李崢艷,時(shí)瑩瑜,李立. 多層螺旋CT和經(jīng)直腸超聲在直腸癌術(shù)前分期中的價(jià)值. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(9): 702-705. doi: 復(fù)制

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國(guó)普外基礎(chǔ)與臨床雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

1. 汪曉東, 呂東昊, 曾天芳, 等. 多學(xué)科協(xié)作診治模式下結(jié)直腸癌術(shù)前輔助檢查系統(tǒng)的臨床應(yīng)用初步探索 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(1): 7074.
2. 汪曉東, 何帆, 鄧窈窕, 等. 直腸癌術(shù)前經(jīng)直腸超聲評(píng)估保肛或非保肛手術(shù)方案的臨床前瞻性研究 [Ｊ]. 臨床外科雜志, 2008; 16(11): 755757.
3. Engelen SM, Beets GL, BeetsTan RG. Role of preoperative local and distant staging in rectal cancer [Ｊ]. Onkologie, 2007; 30(3): 141145.
4. Theoni RF. Colorectal cancer: crosssectional imaging for staging of primary tumor and detection of local recurrence [Ｊ]. AJR Am J Roentgenol, 1991; 156(5): 909915.
5. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound [Ｊ]. Dis Colon Rectum, 1985; 28(1): 4246.
6. Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York (NY): Springer Verlag, 2002: 113124.
7. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncologyrectal cancer, v.4.2008, http: //www.nccn.org/professionals/physician_gls/PDF/rectal.pdf.
8. 汪曉東, 呂東昊, 崔貝貝, 等. 術(shù)前經(jīng)直腸超聲評(píng)估直腸癌手術(shù)方案的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)循證醫(yī)學(xué)雜志, 2008; 8(12): 10431046.
9. Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer [Ｊ]. Int J Colorectal Dis, 2000; 15(1): 920.
10. Rifkin MD, Ehrlich SM, Marks G. Staging of rectal carcinoma: prospective comparison of endorectal US and CT [Ｊ]. Radiology, 1989; 170(2): 319322.
11. Hünerbein M. Endorectal ultrasound in rectal cancer [Ｊ]. Colorectal Dis, 2003; 5(5): 402405.
12. Dinter DJ, Hofheinz RD, Hartel M, et al. Preoperative staging of rectal tumors: comparison of endorectal ultrasound, hydroCT, and highresolution endorectal MRI [Ｊ]. Onkologie, 2008; 31(5): 230235.
13. Panzironi G, De Vargas Macciucca M, Manganaro L, et al. Preoperative locoregional staging of rectal carcinoma: comparison of MR, TRUS and Multislice CT. Personal experience [Ｊ]. Radiol Med, 2004; 107(4): 344355.
14. Matsuoka H, Nakamura A, Masaki T, et al. Preoperative staging by multidetectorrow computed tomography in patients with rectal carcinoma [Ｊ]. Am J Surg, 2002; 184(2): 131135.
15. Bipat S, Glas AS, Slors FJ, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT and MR imaging-a metaanalysis [Ｊ]. Radiology, 2004; 232(3): 773783.
16. Kim JC, Kim HC, Yu CS, et al. Efficacy of 3dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging [Ｊ]. Am J Surg, 2006; 192(1): 8997.
17. Birnbaum EH. What’s new in colon and rectal surgery [Ｊ]. J Am Coll Surg, 2006; 202(3): 485494.
18. Goertz RS, Fein M, Sailer M. Impact of biopsy on the accuracy of endorectal ultrasound staging of rectal tumors [Ｊ]. Dis Colon Rectum, 2008; 51(7): 11251129.
19. Karantanas AH, Yarmenitis S, Papanikolaou N, et al. Preoperative imaging staging of rectal cancer [Ｊ]. Dig Dis, 2007; 25(1): 2032.
20. Dworak O. Number and size of lymph nodes and node metastases in rectal carcinomas [Ｊ]. Surg Endosc, 1989; 3(2): 9699.
21. Mnig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [Ｊ]. Ann Surg Oncol, 1999; 6(6): 579581.
22. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85118.
23. 汪曉東, 宋歡, 呂東昊, 等. 術(shù)前聯(lián)合評(píng)估直腸上段癌與手術(shù)方案選擇的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(4): 322326.
24. 汪曉東, 尹源, 陸玫竹, 等. 經(jīng)直腸超聲聯(lián)合血清淀粉樣蛋白A術(shù)前評(píng)估中低位直腸癌與手術(shù)決策的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(5): 407412.
  1. 1. 汪曉東, 呂東昊, 曾天芳, 等. 多學(xué)科協(xié)作診治模式下結(jié)直腸癌術(shù)前輔助檢查系統(tǒng)的臨床應(yīng)用初步探索 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(1): 7074.
  2. 2. 汪曉東, 何帆, 鄧窈窕, 等. 直腸癌術(shù)前經(jīng)直腸超聲評(píng)估保肛或非保肛手術(shù)方案的臨床前瞻性研究 [Ｊ]. 臨床外科雜志, 2008; 16(11): 755757.
  3. 3. Engelen SM, Beets GL, BeetsTan RG. Role of preoperative local and distant staging in rectal cancer [Ｊ]. Onkologie, 2007; 30(3): 141145.
  4. 4. Theoni RF. Colorectal cancer: crosssectional imaging for staging of primary tumor and detection of local recurrence [Ｊ]. AJR Am J Roentgenol, 1991; 156(5): 909915.
  5. 5. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound [Ｊ]. Dis Colon Rectum, 1985; 28(1): 4246.
  6. 6. Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York (NY): Springer Verlag, 2002: 113124.
  7. 7. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncologyrectal cancer, v.4.2008, http: //www.nccn.org/professionals/physician_gls/PDF/rectal.pdf.
  8. 8. 汪曉東, 呂東昊, 崔貝貝, 等. 術(shù)前經(jīng)直腸超聲評(píng)估直腸癌手術(shù)方案的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)循證醫(yī)學(xué)雜志, 2008; 8(12): 10431046.
  9. 9. Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer [Ｊ]. Int J Colorectal Dis, 2000; 15(1): 920.
  10. 10. Rifkin MD, Ehrlich SM, Marks G. Staging of rectal carcinoma: prospective comparison of endorectal US and CT [Ｊ]. Radiology, 1989; 170(2): 319322.
  11. 11. Hünerbein M. Endorectal ultrasound in rectal cancer [Ｊ]. Colorectal Dis, 2003; 5(5): 402405.
  12. 12. Dinter DJ, Hofheinz RD, Hartel M, et al. Preoperative staging of rectal tumors: comparison of endorectal ultrasound, hydroCT, and highresolution endorectal MRI [Ｊ]. Onkologie, 2008; 31(5): 230235.
  13. 13. Panzironi G, De Vargas Macciucca M, Manganaro L, et al. Preoperative locoregional staging of rectal carcinoma: comparison of MR, TRUS and Multislice CT. Personal experience [Ｊ]. Radiol Med, 2004; 107(4): 344355.
  14. 14. Matsuoka H, Nakamura A, Masaki T, et al. Preoperative staging by multidetectorrow computed tomography in patients with rectal carcinoma [Ｊ]. Am J Surg, 2002; 184(2): 131135.
  15. 15. Bipat S, Glas AS, Slors FJ, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT and MR imaging-a metaanalysis [Ｊ]. Radiology, 2004; 232(3): 773783.
  16. 16. Kim JC, Kim HC, Yu CS, et al. Efficacy of 3dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging [Ｊ]. Am J Surg, 2006; 192(1): 8997.
  17. 17. Birnbaum EH. What’s new in colon and rectal surgery [Ｊ]. J Am Coll Surg, 2006; 202(3): 485494.
  18. 18. Goertz RS, Fein M, Sailer M. Impact of biopsy on the accuracy of endorectal ultrasound staging of rectal tumors [Ｊ]. Dis Colon Rectum, 2008; 51(7): 11251129.
  19. 19. Karantanas AH, Yarmenitis S, Papanikolaou N, et al. Preoperative imaging staging of rectal cancer [Ｊ]. Dig Dis, 2007; 25(1): 2032.
  20. 20. Dworak O. Number and size of lymph nodes and node metastases in rectal carcinomas [Ｊ]. Surg Endosc, 1989; 3(2): 9699.
  21. 21. Mnig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [Ｊ]. Ann Surg Oncol, 1999; 6(6): 579581.
  22. 22. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85118.
  23. 23. 汪曉東, 宋歡, 呂東昊, 等. 術(shù)前聯(lián)合評(píng)估直腸上段癌與手術(shù)方案選擇的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(4): 322326.
  24. 24. 汪曉東, 尹源, 陸玫竹, 等. 經(jīng)直腸超聲聯(lián)合血清淀粉樣蛋白A術(shù)前評(píng)估中低位直腸癌與手術(shù)決策的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(5): 407412.