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目的探讨多学科协作模式(MDT)下经直肠超声(TRUS)、64排多层螺旋CT(MSCT)和血清淀粉样蛋白A(SAA)多模式术前评估在中、低位直肠癌临床外科决策中的应用价值。方法前瞻性纳入2008年7月至2009年3月本院的中、低位直肠癌患者(肿瘤下缘距齿状线≤10cm),随机均分为MPE组(术前行TRUS、MSCT和SAA联合评估),MSCT+SAA组(术前行MSCT和SAA联合评估)和MSCT组,将术前分期和预测手术方案分别与术后病理分期和实际手术方案比较,并分析手术方案选择与临床病理因素的关系。结果本研究实际纳入病例218例,MPE组74例,MSCT+SAA组72例,MSCT组72例,3组基线情况一致。MPE组术前T、N、M和TNM分期的准确度分别为94.6%、85.1%、100%和82.4%;MSCT+SAA组的术前T、N、M和TNM分期的准确度分别为77.8%、84.7%、100%和81.9%;MSCT组的术前T、N、M和TNM分期的准确度分别为80.6%、69.4%、100%和70.8%。3组的术前T分期准确度差异有统计学意义(P=0.003,P=0.010),3组的术前N分期准确度差异有统计学意义(P=0.023,P=0.029)。3组手术方案的预测符合率分别为95.9%、88.9%和80.6%,MPE组和MSCT组之间差异有统计学意义(P=0.001)。分析中、低位直肠癌手术方案的选择与多种临床病理因素的关系发现,pT分期(P<0.001)、pN分期(P<0.001)、pTNM分期(P<0.001)、术前血清SAA水平(P=0.002)和肿瘤下缘距齿状线距离(P=0.030)与中、低位直肠癌手术方案的选择相关。结论 MPE可以实现目前最为准确的中、低位直肠癌术前分期准确性,为手术方案预测提供可靠的客观依据。
Objective To investigate the multimodal modality (MDT) multi-modality preoperative evaluation of transrectal ultrasound (TRUS), multi-slice spiral CT (MSCT) and serum amyloid A (SAA) The application value. Methods The patients with moderate and low rectal cancers in our hospital from July 2008 to March 2009 were prospectively enrolled. The lower margin of the tumor was less than 10 cm from the dentate line, and were randomly divided into MPE group (preoperative TRUS, MSCT and SAA MSCT + SAA group (preoperative MSCT and SAA joint assessment) and MSCT group, the preoperative staging and predictive surgical plans were compared with the postoperative pathological staging and actual surgical plans, and analysis of surgical options and clinical pathological factors Relationship. Results In this study, 218 cases were actually included in the study. There were 74 cases in the MPE group, 72 cases in the MSCT + SAA group and 72 cases in the MSCT group. The baseline conditions of the 3 groups were the same. The accuracy of preoperative T, N, M and TNM staging in MPE group was 94.6%, 85.1%, 100% and 82.4% respectively. The accuracy of preoperative T, N, M and TNM staging in MSCT + SAA group was 77.8 %, 84.7%, 100% and 81.9% respectively. The accuracy of preoperative T, N, M and TNM staging of MSCT group were 80.6%, 69.4%, 100% and 70.8% respectively. The accuracy of preoperative T staging in the three groups was statistically significant (P = 0.003, P = 0.010). The accuracy of preoperative N staging in the three groups was statistically significant (P = 0.023, P = 0.029). The coincidence rates of the three groups were 95.9%, 88.9% and 80.6%, respectively. There was a significant difference between the MPE group and the MSCT group (P = 0.001). Analysis of the relationship between the selection of low rectal cancer surgical plans and various clinicopathological factors showed that there was no significant difference in pT stage (p <0.001), pN stage (p <0.001), pTNM stage (p <0.001), preoperative serum SAA level P = 0.002) and the lower margin of the tumor from the dentate line (P = 0.030) were associated with the choice of surgical options for low and middle rectal cancer. Conclusion MPE can achieve the most accurate preoperative staging accuracy of middle and low rectal cancer and provide a reliable and objective basis for the prediction of surgical plans.