CAJ | 학술논문

为探讨多排螺旋CT(MSCT)及后处理技术在结肠癌诊断的应用价值,2013年6月至2014年6月南京医科大学附属无锡二院收集经手术病理学检查证实的57例结肠癌患者资料进行分析.患者行MSCT平扫及增强检查,图像行多平面重组(MPR)、滑动薄层最大密度投影(STS-MIP)、曲面重组(CPR)后处理,并与术后病理TNM分期比较.57例患者中,肿瘤位于盲肠1例,升结肠23例,结肠肝曲9例,横结肠11例,结肠脾曲1例,降结肠3例,乙状结肠9例.MSCT检查与术中探查结果一致.57例患者肠壁均不规则环状增厚,增厚范围为0.6 ～3.2 cm,存在不同程度的肠腔狭窄;16例患者出现液气平,伴有肠腔扩张,表现为肠梗阻征象.42例患者有软组织结节或包块影,表现为软组织结节或包块向肠腔内和(或)肠腔外生长,导致肠腔不同程度狭窄.包块与周围肠壁分界可以清楚或者边界模糊,周围肠壁厚度正常.20例患者形成癌性溃疡.溃疡表现为火山口状.47例患者出现浆膜层和(或)周围脏器受侵犯.27例患者发生淋巴结转移.6例患者发生远处转移,其中4例肝转移,2例肺转移.术前MSCT检查T分期的灵敏度为100.0％ (57/57),准确度为77.2％ (44/57);术前MSCT检查N分期灵敏度为67.9％ (19/28),特异度为72.4％ (21/29),准确度为70.2％ (40/57);术前MSCT检查M分期灵敏度为100.0％ (6/6),特异度为100.0％ (51/51),准确度100.0％(57/57),术前MSCT检查TNM分期结果与术后病理学检查分期一致性较好(κ =0.592,0.514,1.000,P＜0.05).MSCT扫描及后处理的应用可有效显示结肠癌的部位、大小和形态,确定肿瘤侵犯范围、有无淋巴结及远处转移等,可以准确进行术前TNM分期,具有较高的临床应用价值.
위탐토다배라선CT(MSCT)급후처리기술재결장암진단적응용개치,2013년6월지2014년6월남경의과대학부속무석이원수집경수술병이학검사증실적57례결장암환자자료진행분석.환자행MSCT평소급증강검사,도상행다평면중조(MPR)、활동박층최대밀도투영(STS-MIP)、곡면중조(CPR)후처리,병여술후병리TNM분기비교.57례환자중,종류위우맹장1례,승결장23례,결장간곡9례,횡결장11례,결장비곡1례,강결장3례,을상결장9례.MSCT검사여술중탐사결과일치.57례환자장벽균불규칙배상증후,증후범위위0.6 ～3.2 cm,존재불동정도적장강협착;16례환자출현액기평,반유장강확장,표현위장경조정상.42례환자유연조직결절혹포괴영,표현위연조직결절혹포괴향장강내화(혹)장강외생장,도치장강불동정도협착.포괴여주위장벽분계가이청초혹자변계모호,주위장벽후도정상.20례환자형성암성궤양.궤양표현위화산구상.47례환자출현장막층화(혹)주위장기수침범.27례환자발생림파결전이.6례환자발생원처전이,기중4례간전이,2례폐전이.술전MSCT검사T분기적령민도위100.0％ (57/57),준학도위77.2％ (44/57);술전MSCT검사N분기령민도위67.9％ (19/28),특이도위72.4％ (21/29),준학도위70.2％ (40/57);술전MSCT검사M분기령민도위100.0％ (6/6),특이도위100.0％ (51/51),준학도100.0％(57/57),술전MSCT검사TNM분기결과여술후병이학검사분기일치성교호(κ =0.592,0.514,1.000,P＜0.05).MSCT소묘급후처리적응용가유효현시결장암적부위、대소화형태,학정종류침범범위、유무림파결급원처전이등,가이준학진행술전TNM분기,구유교고적림상응용개치.
In order to investigate the clinical value of multi-slice computed tomography (MSCT) in the diagnosis of colonic neoplasms,the clinical data of 57 patients who were confirmed as with colonic neoplasms were admitted to the Wuxi No.2 People's Hospital from June 2013 to June 2014.Patients received plain and enhanced scan of MSCT,multiplannar reconstruction (MPR),sliding thin-slab maximum intensity projection (STS-MIP) and curved planar reformation (CPR),and the results of these examinations were compared with the postoperative TNM stage.Of the 57 patients,tumors located at the cecum in 1 patient,ascending colon in 23 patients,hepatic region of the colon in 9 patients,transverse colon in 11 patients,splenic region of the colon in 1 patient,descending colon in 3 patients and sigmoid colon in 9 patients.The results of the CT examination were in accordance with the results of exploratory laparotomy.The wall of the intestine was irregular ring-like thickened in 57 patients.The thickening of the intestine ranged between 0.6-3.2 cm,and patients had intestinal stricture in different degrees.Sixteen patients had gas-fluid level and dilatation of the intestine and were presented with intestinal obstruction signs.Forty-two patients had nodular or mass shadow in sofi tissues,and the nodules or mass protruded into the intestinal cavity or outside of the intestinal cavity,and resulting in intestinal stricture.The junction of the mass and the adjacent intestinal wall was blurred or clear,and the thickness of the intestinal walls was normal.Carcinomatous ulcer was observed in 20 patients.The shape of the ulcer was crateriform.The serosa and (or) adjacent organs were invaded by the tumors in 47 patients.Twenty-seven patients had lymph node metastasis,including 6 had distal metastasis,4 had hepatic metastasis and 2 had pulmonary metastasis.The sensitivity and accuracy of the preoperative CT examination for T stage were 100.0％ (57/57) and 77.2％ (44/57),respectively.The sensitivity,specificity and accuracy of the CT examination for N stage were 67.9％ (19/28),72.4％ (21/29) and 70.2％ (40/57),respectively.The sensitivity,specificity and accuracy of the CT examination for M stage were 100.0％ (6/6),100.0％ (51/51) and 100.0％ (57/57),respectively.The results of CT examination for TNM stage were well correlated with the pathological examination for TNM stage (κ =0.592,0.514,1.000,P ＜0.05).MSCT scanning and post-processing technique are of important clinical value in depicting tumor location,size and morphology,delineating tumor extension,revealing lymph nodes and metastases,and confirming preoperative tumor TNM stage in patients with colonic neoplasms.