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目的探讨内镜超声(EUS)在结直肠癌术前TNM分期中的应用价值。方法对60例手术切除的结直肠癌患者术前行内镜超声检查,术后进行病理检查,将两者对肿瘤侵犯深度的诊断结果进行比较。结果经EUS检查,发现正常结直肠壁表现为5层结构,第1、3、5层表现为高回声,第2、4层表现为低回声。第1、2层为黏膜层,第3层为黏膜下层,第4层为固有肌层,第5层为浆膜下和浆膜层。EUS下结直肠癌表现为低回声肿块,其回声强度介于第3层高回声和第4层低回声之间。根据EUS下结直肠壁5层结构和邻近器官的改变判断肿瘤侵犯的深度,进行TNM分期诊断。肿瘤旁直径大于或等于5mm圆形的低回声病灶诊断为转移性淋巴结。EUS对本组结直肠癌TNM分期诊断总的准确率为85.0%;周围淋巴结转移诊断的敏感性和特异性为54.8%和66.7%。结论EUS对结直肠癌侵犯深度的判断有较高的准确率,对术前TNM分期诊断有一定价值。术前EUS检查可以为结直肠癌治疗选择合适的方案提供指导。
Objective To investigate the value of endoscopic ultrasonography (EUS) in preoperative TNM staging of colorectal cancer. Methods Sixty patients undergoing resection of colorectal cancer underwent endoscopic ultrasonography and postoperative pathological examination. The diagnostic results of the two were compared between the two groups. Results The results of EUS examination showed that normal colorectal wall showed a five-layer structure, the first, third and fifth layers showed hyperechoic, and the second and fourth layers showed hypoechoic. The first and second layers are the mucosal layer, the third layer is the submucosa, the fourth layer is the muscularis propria, and the fifth layer is the subserosal and serosal layer. EUS colorectal cancer showed hypoechoic mass, the echo intensity between the third layer of hyperechoic and the fourth floor hypoechoic. According to EUS under the 5-layer structure of the colorectal wall and adjacent organs to determine the depth of tumor invasion, TNM staging diagnosis. A metastatic lymph node was diagnosed as a hypoechoic lesion with a tumor diameter of 5 mm or more. The overall accuracy of EUS in diagnosing TNM staging of colorectal cancer was 85.0%. The sensitivity and specificity of diagnosing peripheral lymph node metastasis were 54.8% and 66.7%. Conclusion EUS has a higher accuracy in judging the depth of invasion of colorectal cancer, which is of value in preoperative TNM staging. Preoperative EUS examination can provide guidance for the selection of appropriate regimens for the treatment of colorectal cancer.