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目的行全直肠系膜切除术(TME)探讨影像学对直肠癌病例进行术前评估的价值。方法术前活检病理证实直肠癌63例,进行CT、MR平扫及增强检查(其中CT35例,MR28例)。分析直肠系膜筋膜受累情况、筋膜外淋巴结转移及病灶与肛缘间的曲线距离,结果与术后病理相对照。结果对直肠系膜筋膜受累情况的判断中有2例CT高估,1例MR高估,2组间差异无统计学意义。MR矢状位能清晰显示所有病例的肛缘及肿瘤下缘之间的曲线距离。63例中有37例发现系膜内肿大淋巴结,其中19例病理结果无转移均为反应性增生。16例系膜筋膜外发现肿大淋巴结,其中12例病理结果为转移,4例为反应性增生。结论MSCT及高分辨力MRI对直肠癌患者拟行TME者的术前评估具有重要价值。
Objective To investigate the value of preoperative evaluation of imaging in rectal cancer by total mesorectal excision (TME). Methods Preoperative biopsy confirmed 63 cases of rectal cancer, CT, MR plain scan and enhanced examination (CT35 cases, MR28 cases). Analysis of mesorectal fascia involvement, extrafascial lymph node metastasis and lesion and anal margin curve distance, the results with postoperative pathology. Results In the judgment of the involvement of mesorectal fascia, two cases of CT were over-estimated and one case of MR was over-estimated. There was no significant difference between the two groups. MR sagittal can clearly show the curve between the anal margin and the lower edge of the tumor in all cases. In 63 cases, 37 cases found mesangial lymph nodes, of which 19 cases of pathological findings without metastasis were reactive hyperplasia. 16 cases of mesangial fascia found swollen lymph nodes, of which 12 cases of pathological findings for the transfer, 4 cases of reactive hyperplasia. Conclusion MSCT and high resolution MRI are of great value in preoperative evaluation of TMEs in patients with rectal cancer.