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目的评估薄层CT预测直肠癌直肠筋膜受累的准确程度。方法术前活检病理证实的直肠癌60例,用薄层CT扫描,利用工作站Invert后处理功能,肉眼观察脂肪间隔以及用电子标尺测量脂肪间距两种方法,评估肿瘤直肠筋膜是否受累,并记录肿瘤位置。所有病例均行全直肠系膜切除术(TME),采用连续病理切片法观察手术标本,对照术前CT和术后病理结果,评估CT能否准确预测直肠癌CRM。结果方法一准确预测CRM 54例,敏感度(54/60)90%、特异度(14/18)78%、准确率(40/42)95%、PPV(14/16)88%、NPV(40/44)91%。(Kappa值为0.754,P<0.001)。方法二准确预测CRM 53例,敏感度(53/60)88%、特异度(13/18)72%、准确率(40/42)95%、PPV(13/15)87%、NPV(40/45)89%。(Kappa值为0.767,P<0.001)。两种方法经卡方检验P>0.05无统计学意义。结论术前薄层CT能准确预测直肠癌临近直肠筋膜的受累情况,为临床治疗方案的制订提供可靠依据。
Objective To evaluate the accuracy of thin-slice CT in predicting rectal fascia involvement in rectal cancer. Methods Preoperative biopsy confirmed 60 cases of rectal cancer, using thin-layer CT scan, using the workstation Invert post-processing function, visually observing the fat space and measuring the fat separation with an electronic scale, to evaluate whether the tumor rectal fascia was involved and recorded Position of the tumor. All patients underwent total mesorectal excision (TME). Surgical specimens were examined by serial pathological sections. Preoperative CT and postoperative pathological results were compared to evaluate whether CT can accurately predict rectal cancer CRM. Results Method 1 Accurately predict 54 cases of CRM, sensitivity (54/60) 90%, specificity (14/18) 78%, accuracy (40/42) 95%, PPV (14/16) 88%, NPV ( 40/44) 91%. (Kappa value was 0.754, P<0.001). Method 2 Accurately predict CRM in 53 cases, sensitivity (53/60) 88%, specificity (13/18) 72%, accuracy rate (40/42) 95%, PPV (13/15) 87%, NPV (40) /45)89%. (Kappa value 0.767, P<0.001). There was no statistical significance between the two methods by Chi-square test P>0.05. Conclusion Preoperative thin-slice CT can accurately predict the involvement of rectal fascia in rectal cancer and provide a reliable basis for the development of clinical treatment plans.