本文選題：開塞露 + 直腸癌��； 參考：《北京協(xié)和醫(yī)學(xué)院》2014年碩士論文

【摘要】：第一部分開塞露在直腸癌MRI術(shù)前T1和T2分期中的應(yīng)用 目的：探討使用開塞露進(jìn)行腸道準(zhǔn)備對(duì)直腸磁共振術(shù)前T1分期和T2分期的意義。 材料與方法：回顧性收集2005年9月至2013年12月北京協(xié)和醫(yī)院經(jīng)活檢病理證實(shí)為直腸癌、行術(shù)前MRI檢查(2周)并經(jīng)手術(shù)病理證實(shí)為T1或T2分期直腸癌的患者81例,男51例,女30例,平均年齡64.2±12.2歲(31～88歲)。其中,2012年6月至2013年12月患者45例,男30例,女15例,平均年齡63.4±13.7歲(31-82歲)使用開塞露；2005年9月至2012年5月患者36例,男21例,女15例,平均年齡65.6±11.5歲(35～88歲),未使用開塞露�；颊呷亢炇鹬橥鈺蝗缓蠓謩e將兩組(使用開塞露組和未用開塞露組)的術(shù)后病理分期結(jié)果與術(shù)前MR分期結(jié)果進(jìn)行對(duì)照分析,分別計(jì)算直腸癌磁共振T1、T2分期的敏感度、特異度、準(zhǔn)確度、陽性預(yù)測值、陰性預(yù)測值和T1+T2分期的敏感度；并采用Kappa檢驗(yàn),分析兩組MRI術(shù)前分期與病理分期結(jié)果的一致性。 結(jié)果：采用Kappa檢驗(yàn),經(jīng)統(tǒng)計(jì)分析證實(shí)兩組MRI術(shù)前分期與病理分期結(jié)果的一致性均為中等,k值分別為使用開塞露組0.693,未用開塞露組0.537。使用開塞露組直腸癌磁共振T分期的敏感度、特異度、準(zhǔn)確度、陽性預(yù)測值、陰性預(yù)測值分別為T1分期：76.5%、92.9%、86.7%、86.7%、86.7%；T2分期：78.6%、76.5%、86.7%、84.5%、68.4%。T1+T2分期的敏感度為：77.8%。未使用開塞露組直腸癌磁共振T分期的敏感度、特異度、準(zhǔn)確度、陽性預(yù)測值、陰性預(yù)測值分別為T1分期：57.1%、95.5%、80.6%、88.9%、77.8%；T2分期：77.3%、57.1%、69.4%、73.9%、61.5%。T1+T2分期的敏感度為：69.4%。通過統(tǒng)計(jì)分析證實(shí)使用開塞露組T1分期的敏感度及T2分期特異度、準(zhǔn)確度高于未使用開塞露組(P0.05,單側(cè))。 結(jié)論：使用開塞露進(jìn)行腸道準(zhǔn)備能夠提高直腸癌磁共振T1分期的敏感度、T2分期特異度及準(zhǔn)確度,同時(shí)在一定程度上提高T1和T2分期的診斷準(zhǔn)確性,建議作為直腸癌磁共振檢查的腸道準(zhǔn)備常規(guī)應(yīng)用。 第二部分3T和1.5T MRI在直腸癌術(shù)前腸周脂肪侵潤診斷中應(yīng)用的比較研究 目的：比較3T和1.5T MRI在直腸癌術(shù)前腸周脂肪侵潤診斷中的應(yīng)用價(jià)值。 材料與方法：回顧性收集北京協(xié)和醫(yī)院2012年5月至2014年2月,經(jīng)活檢病理證實(shí)為直腸癌、行術(shù)前MRI檢查(2周)并經(jīng)手術(shù)病理證實(shí)為T2或T3分期的患者79例,男49例,女30例,平均年齡65.3±11.6歲(32-87歲)。其中,2013年5月至2014年2月行3T磁共振檢查患者29例(男16例,女13例),平均年齡64.7±11.3歲(32-81歲)；2012年5月至2014年2月行1.5T磁共振檢查患者50例(男33例,女17例),平均年齡65.5±11.8歲(34-87歲)�；颊呷亢炇鹬橥鈺Ｈ缓蠓謩e將兩組(3T MRI組和1.5T MRI組)的術(shù)后病理分期結(jié)果與術(shù)前MR分期結(jié)果進(jìn)行對(duì)照,分別計(jì)算直腸癌磁共振有/無腸周脂肪侵潤(T3/T2分期)的敏感度、特異度、準(zhǔn)確度、陽性預(yù)測值、陰性預(yù)測值；采用Kappa檢驗(yàn),分析兩組MRI術(shù)前分期與術(shù)后病理分期結(jié)果的一致性。 結(jié)果：統(tǒng)計(jì)分析證實(shí)兩組術(shù)前MRI分期與術(shù)后病理分期結(jié)果的一致性均為中等,K值分別為3T MRI組0.712,1.5T MRI組0.689。3T MRI組直腸癌磁共振有/無腸周脂肪侵潤的敏感度、特異度、準(zhǔn)確度、陽性預(yù)測值、陰性預(yù)測值分別為無腸周脂肪侵潤(T2期)：90.9%、94.4%、93.1%、90.9%和94.4%；有腸周脂肪侵潤(T3期)：94.4%、90.9%、93.1%、94.4%和90.9%。1.5T MRI組分別為無腸周脂肪侵潤(T2期)：71.4%、81.8%、76.0%、83.3%和69.2%；有腸周脂肪侵潤(T3期)：81.8%、78.6%、80.0%、75.0%和84.6%。通過統(tǒng)計(jì)分析證實(shí)3T MRI組有/無腸周脂肪侵潤(T3/T2分期)的敏感度、特異度、準(zhǔn)確度、陽性預(yù)測值、陰性預(yù)測值均高于1.5T MRI組(P(0.05,單側(cè))。 結(jié)論：與1.5T相比,3T磁共振能夠提高診斷直腸癌有/無腸周脂肪侵潤(T3/T2期)的準(zhǔn)確性,對(duì)直腸磁共振T3和T2分期有較高的價(jià)值。本文中提出的直腸癌MRI局部浸潤征象的診斷參考標(biāo)準(zhǔn)具有一定的應(yīng)用價(jià)值。 第三部分ADC值與直腸腺癌分化程度間的相關(guān)性研究 目的：探討ADC值與直腸黏液腺癌、不同分化程度的直腸腺癌間的關(guān)系。 材料與方法：收集2012年5月至2014年2月北京協(xié)和醫(yī)院經(jīng)活檢病理證實(shí)為直腸癌、行術(shù)前MRI檢查(2周)并經(jīng)手術(shù)病理證實(shí)為直腸黏液腺癌或不同分化程度的直腸腺癌的患者88例,男51例,女37例,平均年齡65.8±13.1歲(35～87歲)。其中,直腸黏液腺癌9例,占10.2%,直腸腺癌79例,高分化(包括中-高分化13例)、中分化、低分化分別為31、40和8例�；颊呷亢炇鹬橥鈺�。所有患者均行DWI掃描(b=1000),并在工作站上測出病灶A(yù)DC值,然后分別將黏液腺癌組和全部腺癌組的ADC值進(jìn)行比較；將黏液腺癌組和腺癌高分化、中分化、低分化組的ADC值進(jìn)行兩兩比較,并分析ADC值在不同病理類型及分化程度直腸癌中的差異。 結(jié)果：直腸黏液腺癌組、全部腺癌組、腺癌高分化、中分化、低分化組的平均ADC值分別為(1.362±0.124)×10q-3mm2/s、(0.949±0.146).(1.129±0.128)×10-3mm2/s、(0.865±0.143)×10-3mm2s、(0.672±0.196)×10-3mm2/s,通過統(tǒng)計(jì)分析證實(shí)黏液腺癌組和全部腺癌組ADC值的差異具有統(tǒng)計(jì)學(xué)意義(P0.05),黏液腺癌組的ADC值高于腺癌組；黏液腺癌組與腺癌高、中、低分化組ADC值兩兩間差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),黏液腺癌組的ADC值高于腺癌高、中、低分化組；并且腺癌ADC值隨腫瘤分化程度的升高而升高。 結(jié)論：ADC值有助于鑒別直腸黏液腺癌與不同分化程度的直腸腺癌,ADC值與直腸腺癌分化程度呈正相關(guān)。
[Abstract]:Part one application of Enema Glycerini in T1 and T2 staging of rectal cancer before MRI operation
Objective: To investigate the significance of Enema Glycerini preparation for bowel preparation in preoperative T1 staging and T2 staging of rectal magnetic resonance.
Materials and methods: a retrospective collection of 81 cases of rectal cancer confirmed by biopsy by biopsy in Peking Union Medical College Hospital from September 2005 to December 2013, with preoperative MRI examination (2 weeks) and T1 or T2 staging rectal cancer confirmed by operation and pathology, 51 males and 30 females, with an average age of 64.2 + 12.2 years (31~88 years). Among them, 45 cases were from June 2012 to December 2013. 30 men and 15 women, with an average age of 63.4 + 13.7 years (31-82 years old) using Enema Glycerini; 36 cases, 21 men and 15 women from September 2005 to May 2012, average age 65.6 + 11.5 years (35~88 years old), not using Enema Glycerini. Patients were all signed informed consent; then the postoperative pathology of the two group (using the Enema Glycerini group and the unused Enema Glycerini group) was followed by the postoperative pathology. The staging results were compared with the results of preoperative MR staging, and the sensitivity, specificity, accuracy, positive predictive value, negative predictive value and T1+T2 staging of rectal cancer T1, T2 staging, and the sensitivity of negative predictive value and T1+T2 staging were calculated respectively, and the consistency between the two groups of preoperative staging and pathological staging was analyzed by Kappa test.
Results: by Kappa test, the statistical analysis showed that the consistency of the two groups of MRI preoperative staging and pathological staging were all moderate, K value was 0.693 in Enema Glycerini group, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the Enema Glycerini group 0.537. were not used for the T staging of rectal cancer in the group of Enema Glycerini. The negative predictive values were T1 points, respectively. Period: 76.5%, 92.9%, 86.7%, 86.7%, 86.7%; T2 staging: the sensitivity of the 78.6%, 76.5%, 86.7%, 84.5%, and 68.4%.T1+T2 staging: the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the 77.8%. staging of rectal cancer in the Enema Glycerini group were T1 staging, 57.1%, 95.5%, 80.6%, 88.9%, 77.8%; T2 staging, respectively, The sensitivity of 69.4%, 73.9%, 61.5%.T1+T2 staging was: 69.4%. by statistical analysis proved that the sensitivity of T1 staging and the specificity of T2 staging were used in Enema Glycerini group, and the accuracy was higher than that of the unused Enema Glycerini group (P0.05, unilateral).
Conclusion: the use of Enema Glycerini for intestinal preparation can improve the sensitivity of MRI T1 staging of rectal cancer, the specificity and accuracy of T2 staging, and improve the diagnostic accuracy of T1 and T2 staging to a certain extent. It is recommended to be used as the routine application of the bowel preparation for rectal cancer magnetic resonance examination.
The second part is a comparative study of 3T and 1.5T MRI in the diagnosis of preoperative peri intestinal fat infiltration in rectal cancer.
Objective: To compare the diagnostic value of 3T and 1.5T MRI in preoperative peri intestinal fat infiltration in rectal cancer.
Materials and methods: a retrospective collection of Peking Union Medical College Hospital from May 2012 to February 2014, with biopsy pathology confirmed rectal cancer, preoperative MRI examination (2 weeks) and 79 cases of T2 or T3 staging confirmed by surgery and pathology, 49 males and 30 females, with an average age of 65.3 + 11.6 years (32-87 years). Among them, 3T MRI was performed from May 2013 to February 2014. 29 cases (male 16, female 13), the average age of 64.7 + 11.3 years (32-81 years); from May 2012 to February 2014, 50 patients (33 men, 17 cases) and average age 65.5 + 11.8 years (34-87 years old) were performed by 1.5T MRI. The patients were all signed informed consent. Then the postoperative pathological staging results of the two group (group 3T MRI and 1.5T MRI) were compared with preoperative MR respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of rectal cancer / T3/T2 staging (T3/T2 staging) were calculated by staging results, and the results of preoperative staging and postoperative pathological staging of two groups were analyzed by Kappa test.
Results: the statistical analysis showed that the consistency of preoperative MRI staging and postoperative pathological staging were all moderate, and the K value was the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 0.712,1.5T MRI group 0.689.3T MRI in group 3T MRI group 0.689.3T MRI, respectively, without enteral fat invasion (T2 stage), respectively. 90.9%, 94.4%, 93.1%, 90.9%, and 94.4%; group:94.4%, 90.9%, 93.1%, 94.4%, and 90.9%.1.5T MRI of perienteral fat invasion (T2 phase):71.4%, 81.8%, 76%, 83.3% and 69.2%, respectively, with periac fat invasion (T3 phase):81.8%, 78.6%, 80%, and 84.6%. through statistical analysis to confirm that 3T MRI group had / without intestinal lipid. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of fat infiltration (T3/T2 staging) were higher than those of 1.5T MRI group (P (0.05, unilateral).
Conclusion: compared with 1.5T, 3T MRI can improve the accuracy of diagnosis of rectal cancer / perienteral fat invasion (T3/T2 phase). It is of high value for rectal MRI T3 and T2 staging. The diagnostic reference standard for local invasion of rectal cancer in this paper is of certain value.
The third part is the correlation between ADC value and the differentiation degree of rectal adenocarcinoma.
Objective: To investigate the relationship between ADC and rectal mucinous adenocarcinoma and rectal adenocarcinoma with different degree of differentiation.
Materials and methods: 88 cases of rectal mucinous adenocarcinoma or different degree of rectal adenocarcinoma confirmed by preoperative MRI examination (2 weeks) and 88 cases of rectal adenocarcinoma with different degrees of differentiation were confirmed by biopsy of the Peking Union Medical College Hospital from May 2012 to February 2014. The rectal mucous glands of the rectum were 65.8 + 13.1 years old (35~87 years). 9 cases were cancer, 79 cases of rectal adenocarcinoma, high differentiation (including middle and high differentiation 13 cases), middle differentiation, low differentiation 31,40 and 8 cases. All patients signed informed consent. All patients underwent DWI scan (b=1000), and the ADC value of the lesion was measured on the workstation. Then the ADC value of mucous adenocarcinoma group and all adenocarcinoma group was compared, and the viscosity of the mucous adenocarcinoma group was compared. The ADC values of the high differentiation, middle differentiation, and low differentiation group were compared in the liquid adenocarcinoma group and the adenocarcinoma group, and the difference in the ADC value in the different pathological types and the differentiation degree of the rectal cancer was analyzed.
Results: the average ADC value of all adenocarcinoma group, all adenocarcinoma group, high differentiation, middle differentiation and low differentiation group was (1.362 + 0.124) x 10q-3mm2/s, (0.949 + 0.146). (1.129 + 0.128) x 10-3mm2/s, (0.865 + 0.143) x 10-3mm2s and (0.672 + 0.196) x 10-3mm2/s. The difference of ADC value between mucous adenocarcinoma group and all adenocarcinoma group was confirmed by statistical analysis. The difference was statistically significant (P0.05). The value of ADC in the mucous adenocarcinoma group was higher than that in the adenocarcinoma group, and the 22 differences between the mucous adenocarcinoma group and the adenocarcinoma, middle and low differentiation group were all statistically significant (P0.05). The ADC value of the mucous adenocarcinoma group was higher than that of the adenocarcinoma, middle and low differentiation group, and the ADC value of adenocarcinoma increased with the increase of the degree of tumor differentiation.
Conclusion: ADC is helpful in differentiating rectal mucinous adenocarcinoma from rectal adenocarcinoma with different degree of differentiation. ADC is positively correlated with the differentiation degree of rectal adenocarcinoma.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.37;R445.2

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