CAJ | 학술논문

目的分析研究64层螺旋CT对大肠癌术前分期预测及腹腔镜手术方案的准确性及应用价值。方法我院在2008年12月至2012年2月期间共接诊80例大肠癌患者，在术前均通过64层螺旋CT进行扫描并进行后期图像重建等技术处理，记录术前的CT-TNM分期及预计的手术方案，与术后的病理分期以及实际的手术方案作对比。结果64层螺旋CT的诊断符合率为100%，其中CT仿真肠镜可以显示出大肠癌大体的分型，准确性为91.3%；透明显示图像（Raysum）可以较准确地显示出癌肿的范围以及长度，准确性为100%；MPR（多平面重建）可以直观准确地显示癌肿和肠周受到侵犯的程度，准确率为100%。术前评估T分期：其中对T0、T1及T4的敏感性较高，分别为100%、100%、92.3%，但对T2期的敏感性比较低，为63.6%，阳性诊断的准确率是88.2%；N分期：对N0和N3期的敏感度最高，为100%，对N2期的敏感性较低仅为50%，总体准确率为85.5%,并且当淋巴结直径＞5mm时，其诊断的准确性也增高；M期：敏感度及准确率均为100%。cTNM的总准确率为79.5%,与术后病理分期保持高度一致性(κ=0.821，P=0.0)。并且64层螺旋CT在术前预测的手术方式和实际的手术方式保有较高的一致性（κ=0.314，P=0.0）。结论64层螺旋CT能有效地显示出肠癌的部位、形态和大小，能准确地对其进行诊断及术前临床分期，准确的制定腹腔镜手术的实施方案，因此应在临床中推广应用。
목적분석연구64층라선CT대대장암술전분기예측급복강경수술방안적준학성급응용개치。방법아원재2008년12월지2012년2월기간공접진80례대장암환자，재술전균통과64층라선CT진행소묘병진행후기도상중건등기술처리，기록술전적CT-TNM분기급예계적수술방안，여술후적병리분기이급실제적수술방안작대비。결과64층라선CT적진단부합솔위100%，기중CT방진장경가이현시출대장암대체적분형，준학성위91.3%；투명현시도상（Raysum）가이교준학지현시출암종적범위이급장도，준학성위100%；MPR（다평면중건）가이직관준학지현시암종화장주수도침범적정도，준학솔위100%。술전평고T분기：기중대T0、T1급T4적민감성교고，분별위100%、100%、92.3%，단대T2기적민감성비교저，위63.6%，양성진단적준학솔시88.2%；N분기：대N0화N3기적민감도최고，위100%，대N2기적민감성교저부위50%，총체준학솔위85.5%,병차당림파결직경＞5mm시，기진단적준학성야증고；M기：민감도급준학솔균위100%。cTNM적총준학솔위79.5%,여술후병리분기보지고도일치성(κ=0.821，P=0.0)。병차64층라선CT재술전예측적수술방식화실제적수술방식보유교고적일치성（κ=0.314，P=0.0）。결론64층라선CT능유효지현시출장암적부위、형태화대소，능준학지대기진행진단급술전림상분기，준학적제정복강경수술적실시방안，인차응재림상중추엄응용。
Objective To analysize the accuracy and application value of64 layer spiral CT on preoperative staging prediction and laparoscopic surgery of colorectal cancer. Method There were 80 patients with colorectal cancer during January 2008 to February 2012, In preoperative ,through 64 layer spiral CT scanning and image reconstruction technology of processing, record the preoperative CT-TNM staging and expected surgical plan, compare with postoperative pathologic staging and the actual operation scheme. Result Diagnostic coincidence rate of 64 layers spiral CT was 100%, CT simulation colonoscopy can show large intestine cancer general classification, the accuracy is 91.3%;Transparent display images (Raysum) can accurately show the scope of tumor and the length, the accuracy is 100%;MPR (multi planar reconstruction) can directly and accurately display of the cancer and the encroaching extent on intestinal, and the accuracy is 100%. Preoperative T stage:the sensitivities on the T0, T1 and T4 are higher( 100%, 100%and 92.3%), respectively, but their sensitivity on T2 stage is low( 63.6%), positive diagnosis accuracy rate is 88.2%;N staging:sensitivity on N0 and N3 stage are highest, at 100%, low sensitivity on the N2 is only 50%, the overall accuracy is 85.5%, and when the lymph node is greater than 5 mm in diameter, the diagnostic accuracy is also higher;M:sensitivity and accuracy were 100%. total accuracy of CTNM is 79.5%, maintain consistency with and the postoperative pathologic staging (kappa=0.821 predominate, P=0.821). And 64 layer spiral CT on preoperative forecast operation mode keeps high consistency with actual operation method (kappa=0.314 predominate, P=0.314). Conclusion 64 layers spiral CT can effectively show the bowel cancer site, shape and size, can accurately diagnose and preoperative clinical stage, accurately work out schemes for the implementation of laparoscopic surgery, so it should be applied in clinical.