经直肠超声对放化疗后直肠癌浸润深度判断价值探讨

摘要

目的 比较术前经直肠超声(TRUS)对未经放化疗及放化疗后直肠癌浸润深度判断的准确性,分析放化疗后TRUS在直肠癌分期中应用价值.rn方法 病例分为2组:术前未经放化疗组179例,术前放化疗组148例,所有病例术前均行TRUS检查,并经手术切除.按直肠癌TNM分期标准进行浸润深度分期,并与手术病理结果对照.rn结果 未经放化疗组直肠癌TRUS的准确性为78.2％ (140/179),TRUS对pT1～pT4各期直肠癌灵敏性分别为83.3％(15/18)、50.0％ (21/42)、88.0％ (95/108)、81.8 (9/11).术前放化疗组直肠癌TRUS准确性为62.2％ (92/148),对pT0～pT4各期灵敏性分别为0、12.5％ (1/8)、42.9％ (21/49)、87.3％ (62/71)、88.9％ (8/9).TRUS对未经放化疗直肠癌浸润深度判断的准确性明显高于放化疗组(P＜0.01),pTI期直肠癌未经放化疗组TRUS灵敏性明显高于放化疗组(P＜0.01),而对pT2～T4各期直肠癌TRUS灵敏性两组比较无显著性差异(P＞0.05).rn结论 放化疗后TRUS对直肠癌浸润深度判断的准确性下降,尤其对放化疗后pT0期及pT1直肠癌准确判断困难.TRUS对pT3及pT4期直肠癌判断的灵敏性较高,放化疗组与未经放化疗组比较无显著性差异.%Objective To evaluate the accuracy of TRUS in the assessment of the invasion depth of rectal cancer with chemoradiation and without chemoradiation, to analyze the clinical value of TRUS in the preoperative staging of rectal cancer with chemoradiation. Methods Patients were divided into two groups: 179 patients without preoperative chemoradiation and 148 patients with preoperative chemoradiation. Patients underwent operations and TRUS preopera-tively. The results of TRUS were compared with the operative and postoperatively pathological findings according to TNM classification. Results The overall accuracy of TRUS for the rectal cancer without chemoradiation was 78. 2% (140/179). The sensitivity of TRUS was 83. 3%(15/18)in pTl rectal cancer, 50. 0% (21/42)in pT2, 88.0%(95/ 108)in pT3, and 81. 8 (9/11) in pT4. The overall accuracy of TRUS for the rectal cancer with chemoradiation is 62. 2%(92/148). The sensitivity of TRUS in pTO rectal cancer was 0, 12. 5%(l/8) in pTl, 42. 9%(21/49)in pT2, 87. 3%(62/71)in pT3, 88. 9%(8/9)in pT4. The overall accuracy of TRUS for the staging of rectal cancer without chemoradiation was significantly higher than that of TRUS for the cases with chemoradiation(P<0. 01). The sensitivity of TRUS for pTl rectal cancer without chemoradiation was significantly higher than that of TRUS for cases with chemoradiation(P<0. 01). The differences were not significant between cases with and without chemoradiation in the sensitivity of TRUS for pT2~T4 rectal cancer(P>0. 05). Conclusions The accuracy of TRUS in the staging for rectal cancer with chemoradiation is less accuracy, and it is difficult to predict rectal cancer with pTO and pTl with chemoradiation correctly. The sensitivity of TRUS for pT3 and pT4 rectal cancer is relatively high,and there is no significant difference between cases with chemoradiation and without chemoradiation.