本文選題：直腸癌　切入點(diǎn)：多層螺旋CT　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的 應(yīng)用多層螺旋CT(MSCT)對(duì)直腸癌患者進(jìn)行術(shù)前檢查,探討MSCT在直腸癌術(shù)前保肛、術(shù)前手術(shù)術(shù)式、腹腔鏡直腸癌可切除性評(píng)估中的應(yīng)用價(jià)值。方法 搜集經(jīng)腸鏡、臨床診斷為直腸癌的146例病例資料,術(shù)前進(jìn)行MSCT平掃及三期動(dòng)態(tài)增強(qiáng)掃描檢查。術(shù)前評(píng)估可保肛的標(biāo)準(zhǔn)包括腫瘤下緣至肛提肌的距離≥1cm、直腸周圍臟器未受侵、直腸周圍無(wú)廣泛淋巴結(jié)及癌結(jié)節(jié)轉(zhuǎn)移、腫瘤大小、位置、腹腔有無(wú)粘連等。以手術(shù)結(jié)果為標(biāo)準(zhǔn),評(píng)價(jià)MSCT直腸癌術(shù)前保肛、術(shù)前手術(shù)術(shù)式、腹腔鏡直腸癌可切除性評(píng)估的準(zhǔn)確性。并對(duì)MSCT術(shù)前評(píng)估結(jié)果與手術(shù)結(jié)果的一致性進(jìn)行分析。結(jié)果 MSCT術(shù)前保肛評(píng)估的敏感度為94.12%(96/102),特異度為57.14%(16/28),準(zhǔn)確率為86.15%(112/130),陽(yáng)性預(yù)測(cè)值為88.89%(96/108),陰性預(yù)測(cè)值為72.73%(16/22)。MSCT術(shù)前評(píng)估與手術(shù)結(jié)果具有較好的一致性(K=0.57,χ~2=41.06,P0.05)。130例手術(shù)患者中:3例經(jīng)肛門局部切除術(shù),28例Miles術(shù),3例Hartmann術(shù),96例Dixon術(shù)。MSCT術(shù)前評(píng)估:33例行Miles術(shù),4例行Hartmann術(shù),88例行Dixon術(shù),5例經(jīng)肛門局部切除術(shù)。MSCT手術(shù)方式評(píng)估符合率為:84.62%。MSCT術(shù)前手術(shù)方式評(píng)估與術(shù)后結(jié)果一致性較好(K=0.653、χ~2=225.352、P0.05)。85例進(jìn)入腹腔鏡治療組患者中40例行腹腔鏡手術(shù),32例行傳統(tǒng)開(kāi)腹手術(shù)。MSCT術(shù)前評(píng)估符合率為:80.56%。MSCT術(shù)前評(píng)估與手術(shù)情況一致性較好(K=0.601、χ~2=26.372、P0.05)。結(jié)論1、MSCT直腸癌術(shù)前保肛、前手術(shù)方式評(píng)估具有較高的準(zhǔn)確率,為臨床手術(shù)治療評(píng)估提供重要依據(jù)。2、MSCT在腹腔鏡直腸癌術(shù)前可切除性評(píng)估中有較高的準(zhǔn)確性,對(duì)于術(shù)前評(píng)估有著重要意義。
[Abstract]:Objective to evaluate the value of MSCT in evaluating the resectability of rectal cancer before operation, preoperative operation and laparoscopic resection of rectal cancer by multilayer spiral CT MSCT. Methods Transenteroscopy was used to evaluate the resectability of rectal cancer. The clinical data of 146 patients with rectal cancer were examined by MSCT plain scan and three phase dynamic contrast-enhanced scan before operation. The preoperative evaluation criteria included the distance from the lower margin of the tumor to the levator ani muscle 鈮，

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