CAJ | 학술논문

目的结合大组织切片技术,评价螺旋CT预测直肠癌直肠系膜浸润程度和环周切缘状态的价值.方法对2007年3月至12月经纤维结肠镜及病理证实的直肠癌患者57例术前行64层螺旋CT增强扫描,预测直肠系膜浸润程度和环周切缘状态.全直肠系膜切除术后,利用大组织切片技术观察直肠系膜浸润程度和环周切缘状态,并与CT预测结果比较.计算螺旋CT预测直肠系膜浸润程度和环周切缘状态的准确率、敏感度、特异度、阳性预测值和阴性预测值.结果肿瘤按直肠系膜浸润深度分级为Ⅰ度、Ⅱ度、Ⅲ度;螺旋CT预测系膜浸润程度总准确率为93.0%(53/57),其中Ⅰ度、Ⅱ度、Ⅲ度预测准确率分别为94.7%、94.7%、96.5%,与术后病理结果之间有较好的一致性(K=0.89,P<0.01).螺旋CT预测直肠癌环周切缘状态准确率93.0%(53/57),敏感度80.0%(12/15),特异度97.6%(41/42),阳性预测值92.3%(12/13),阴性预测值93.2%(41/44),与术后病理结果之间有较好的一致性(κ=0.76,P<0.05).结论螺旋CT可准确预测直肠癌直肠系膜浸润程度和环周切缘状态.可作为术前影像学评估的常规手段.
목적 결합대조직절편기술,평개라선CT예측직장암직장계막침윤정도화배주절연상태적개치.방법 대2007년3월지12월경섬유결장경급병리증실적직장암환자57례술전행64층라선CT증강소묘,예측직장계막침윤정도화배주절연상태.전직장계막절제술후,이용대조직절편기술관찰직장계막침윤정도화배주절연상태,병여CT예측결과비교.계산라선CT예측직장계막침윤정도화배주절연상태적준학솔、민감도、특이도、양성예측치화음성예측치.결과 종류안직장계막침윤심도분급위Ⅰ도、Ⅱ도、Ⅲ도;라선CT예측계막침윤정도총준학솔위93.0%(53/57),기중Ⅰ도、Ⅱ도、Ⅲ도예측준학솔분별위94.7%、94.7%、96.5%,여술후병리결과지간유교호적일치성(K=0.89,P<0.01).라선CT예측직장암배주절연상태준학솔93.0%(53/57),민감도80.0%(12/15),특이도97.6%(41/42),양성예측치92.3%(12/13),음성예측치93.2%(41/44),여술후병리결과지간유교호적일치성(κ=0.76,P<0.05).결론 라선CT가준학예측직장암직장계막침윤정도화배주절연상태.가작위술전영상학평고적상규수단.
Objective To evaluate the value of spiral computed tomography in the preoperative assessment of the degree of tumor infiltration in mesoreetum and circumferential resection margin status of rectal cancer compared with large tissue shee technique. Methods Fifty-seven patients with rectal cancer diagnosed by fibercolonscopy and pathology from March 2007 to December 2007 underwent preoperative 64-layers spiral CT examination. The degree of tumor infiltration in mesorectum and circumferential resection margin status were evaluated. Large tissue slice technique was applied in the pathologic study after the total mesoreetal excision of the rectum to determine the degree of tumor infiltration in mesorectum and the circumferential resection margin status. The spiral CT findings were compared with pathologic results. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the CT results were assessed respectively. Results The overall spiral CT accuracy was 93.0% (53/57) for the degree of tumor infiltration in mesorectum, and it was 94. 7%, 94. 7% and 96. 5% for degree Ⅰ,Ⅱ, Ⅲ infiltration, respectively. Fifty-three cases (93.0%) were accurately predicated with the circumferential resection margin status. The sensitivity, specificity, PPV and NPV of spiral CT measurement was 80. 0%, 97. 6%, 92. 3% and 93.2%, respectively, and was consistent well with the histopathological diagnosis. Conclusions Spiral CT provides accurate preoperative assessment for the degree of tumor infiltration in mesorectum and circumferential resection margin status of rectal cancer.