CAJ | 학술논문

目的探讨三维腔内超声检查在直肠肿瘤经肛门内镜微创手术(TEM)术前分期诊断中的应用价值.方法回顾性分析2012年4月至2013年12月南京中医药大学第三附属医院南京市中医院收治的30例行TEM直肠肿瘤患者的临床资料,患者术前均行三维腔内超声检查.以术后病理学检查结果为金标准,评估三维腔内超声诊断的准确率、灵敏度及特异度,采用κ一致性检验比较三维腔内超声检查与术后病理学检查结果之间的一致性.结果 30例患者术前三维腔内超声诊断T0期25例,T1期3例,T2期2例.术后病理学诊断炎性息肉(pT0期)2例,管状腺瘤(pT0期)6例,绒毛管状腺瘤(pT0期)16例,原位癌(pTis期)2例,pT1期直肠癌2例,pT2期直肠癌2例.三维腔内超声检查对2例患者分期过度,1例pT0期误分为T1期,1例pT1期误分为T2期;1例患者分期不足,pT2期误分为T1期.与术后病理学检查结果比较,三维腔内超声检查对直肠肿瘤分期诊断准确率为90.0％.其中对pT0期、pT1期、pT2期肿瘤诊断准确率分别为96.7％、90.0％、93.3％,灵敏度分别为96.2％、50.0％、50.0％,特异度分别为100.0％、92.8％、96.4％.一致性比较,术前三维腔内超声检查与术后病理学检查一致性好,差异有统计学意义(κ=0.685,P＜0.05).结论三维腔内超声检查对直肠肿瘤术前分期诊断准确率较高,可以为TEM提供可靠的术前评估依据.
목적 탐토삼유강내초성검사재직장종류경항문내경미창수술(TEM)술전분기진단중적응용개치.방법 회고성분석2012년4월지2013년12월남경중의약대학제삼부속의원남경시중의원수치적30례행TEM직장종류환자적림상자료,환자술전균행삼유강내초성검사.이술후병이학검사결과위금표준,평고삼유강내초성진단적준학솔、령민도급특이도,채용κ일치성검험비교삼유강내초성검사여술후병이학검사결과지간적일치성.결과 30례환자술전삼유강내초성진단T0기25례,T1기3례,T2기2례.술후병이학진단염성식육(pT0기)2례,관상선류(pT0기)6례,융모관상선류(pT0기)16례,원위암(pTis기)2례,pT1기직장암2례,pT2기직장암2례.삼유강내초성검사대2례환자분기과도,1례pT0기오분위T1기,1례pT1기오분위T2기;1례환자분기불족,pT2기오분위T1기.여술후병이학검사결과비교,삼유강내초성검사대직장종류분기진단준학솔위90.0％.기중대pT0기、pT1기、pT2기종류진단준학솔분별위96.7％、90.0％、93.3％,령민도분별위96.2％、50.0％、50.0％,특이도분별위100.0％、92.8％、96.4％.일치성비교,술전삼유강내초성검사여술후병이학검사일치성호,차이유통계학의의(κ=0.685,P＜0.05).결론 삼유강내초성검사대직장종류술전분기진단준학솔교고,가이위TEM제공가고적술전평고의거.
Objective To investigate the value of the three-dimensional endorectal ultrasonography (3D-ERUS) in the tumor staging before transanal endoscopic microsurgery (TEM).Methods The clinical data of 30 patients with rectal cancer who underwent 3D-ERUS before TEM at the Nanjing Hospital of Traditional Chinese Medicine from April 2012 to December 2013 were retrospectively analyzed.The accuracy,sensitivity and specificity of the 3D-ERUS were evaluated according to the results of the postoperative pathological examination.The consistency of the results of the 3D-ERUS and postoperative pathological examination were compared by Kappa consistency test.Results Of 30 patients,25 patients in stage T0,3 in stage T1 and 2 in stage T2 were diagnosed by preoperative 3D-ERUS.There were 2 patients (stage pT0) with inflammatory polyp by postoperative pathological diagnosis,6 patients (stage pT0) with tubular adenoma,16 patients (stage pT0) with villioustublar adenoma,2 patients (stage pTis) with carcinoma in situ,2 patients (stage pT1) with tectal adenoma and 2 patients (stage pT2) with rectal adenoma.There were 2 patients with excessive tumor staging by 3D-ERUS,1 patient in stage pT0 was misdiagnosed in stage T1,1 in stage pT1 was misdiagnosed in stage T2 and 1 in stage pT2 was misdiagnosed in stage T1 with insufficient tumor staging.The accuracy of 3D-ERUS in the preoperative tumors staging of TEM was 90.0％ compared with the resuls of postoperative pathological examination.The accuracy,sensitivity and specificity of 3D-ERUS in stage pT0,pTl,and pT2 of TEM were 96.7％,90.0％,93.3％ and 96.2％,50.0％,50.0％ and 100.0％,92.8％,96.4％,respectively.There was a significant difference in the consistency between preoperative 3D-ERUS and postoperative pathological examination (κ =0.685,P ＜ 0.05).Conclusion 3D-ERUS is an accurate clinical method in the preoperative tumors staging of TEM,and can be used as the preoperative assessment for TEM.