本文選題：直腸惡性腫瘤　切入點(diǎn)：術(shù)前分期　出處：《中華腫瘤防治雜志》2017年05期 　論文類型：期刊論文

【摘要】：目的術(shù)前新輔助治療現(xiàn)在已作為中低位進(jìn)展期直腸癌的標(biāo)準(zhǔn)治療模式,對于新輔助之后患者的分期評估尤為重要并且將決定患者的下一步治療方案。本研究將探討磁共振成像(magnetic resonance imaging,MRI)及多層螺旋CT(multisliecs helieal CT,MSCT)在評價術(shù)前新輔助放療或同步放化療(neoadjuvant chemoradiotherapy,NACRT)對中晚期低位直腸癌療效的應(yīng)用價值。方法回顧性分析2011-01-01-2015-12-31新疆腫瘤醫(yī)院經(jīng)腸鏡檢查病理活檢確診的145例進(jìn)展期中低位直腸癌患者,依據(jù)標(biāo)準(zhǔn)化NACRT前、后的盆腔MRI及MSCT資料分成實(shí)驗(yàn)組(MRI組)和對照組(MSCT組)。分析NACRT前后MRI組和MSCT組上腫瘤的體積、TN分期、環(huán)周切緣(circumferential resection margin,CRM)的改變,并與術(shù)后病理結(jié)果分別進(jìn)行對照。結(jié)果 MRI組NACRT后腫瘤完全緩解4例,部分緩解23例,穩(wěn)定8例,進(jìn)展3例,有效率為71.1%;MSCT組NACRT后腫瘤完全緩解16例,部分緩解63例,穩(wěn)定17例,進(jìn)展11例,有效率為72.0%,兩組有效率比較,差異無統(tǒng)計學(xué)意義,χ~2=0.011,P0.05。MRI組術(shù)前T分期、CRM受侵情況的判斷與術(shù)后病理結(jié)果一致性較好(Kappa=0.546、0.685),而N分期與術(shù)后病理結(jié)果一致性較差(Kappa=0.333);MSCT組術(shù)前T分期、CRM受累情況的判斷與術(shù)后病理結(jié)果一致性較好(Kappa=0.503、0.650),而N分期與術(shù)后病理結(jié)果一致性較差(Kappa=0.299)。兩組影像學(xué)分期分別與術(shù)后病理結(jié)果進(jìn)行對照比較:(1)T分期,兩組比較差異無統(tǒng)計學(xué)意義,χ~2=1.287,P0.05;(2)N分期,兩組比較差異無統(tǒng)計學(xué)意義,χ~2=0.154,P0.05;(3)CRM受累情況,兩組比較差異無統(tǒng)計學(xué)意義,χ~2=0.344,P0.05。結(jié)論 NACRT可以有效縮小腫瘤的體積,降低腫瘤分期,但對CRM受侵情況并無明顯改善。MRI和MSCT可以較為準(zhǔn)確的判斷腫瘤浸潤程度,但對于淋巴結(jié)轉(zhuǎn)移的檢測準(zhǔn)確性較差,MRI的一致性優(yōu)于MSCT,但準(zhǔn)確性無明顯差異。
[Abstract]:Objective preoperative neoadjuvant therapy has become the standard mode of treatment for advanced middle and low rectal cancer. This study will explore magnetic resonance imaging (MRI) and multilayer spiral CT(multisliecs helieal CT (MSCT) in the evaluation of preoperative neoadjuvant radiotherapy or simultaneous radiotherapy. The clinical value of neoadjuvant chemotherapy in the treatment of middle and advanced low rectal cancer was analyzed retrospectively. Methods 145 patients with advanced low rectal cancer diagnosed by endoscopy and biopsy in Xinjiang tumor Hospital were retrospectively analyzed. The pelvic MRI and MSCT data before and after standardized NACRT were divided into experimental group and control group. The changes of tumor volume and TN stage and circumferential circumferential resection margin were analyzed before and after NACRT in MRI group and MSCT group. Results there were 4 cases of complete remission, 23 cases of partial remission, 8 cases of stability and 3 cases of progress after NACRT in MRI group. The effective rate was 16 cases of complete remission, 63 cases of partial remission and 17 cases of stability after NACRT in MRI group. There were 11 cases of progress, the effective rate was 72.0 and the effective rate was compared between the two groups. There was no significant difference between the two groups. The difference between preoperative T staging and CRM involvement in MRI group was better than that in Kappa-0.546 ~ 0.685 group, but the difference between N stage and postoperative pathological results was not good. The diagnosis of preoperative T stage CRM involvement in Kappa-0.333 ~ MSCT group was better than that in postoperative pathological results. The consistency of pathological results was better than that of Kappa's 0.503n 0.650, but the N stage was not consistent with the postoperative pathological results 0.299%. The imaging staging of the two groups was compared with the postoperative pathological results, and compared with the pathological results of the two groups, the two groups were compared with the postoperative pathological results, and compared with the postoperative pathological results, the two groups were divided into two groups. There was no statistically significant difference between the two groups, 蠂 ~ (2 +) ~ (2) (1.287) P _ (0.05) ~ (2) N staging, there was no significant difference between the two groups, 蠂 ~ (2 +) (0.154) (P 0.05) was involved, and there was no significant difference between the two groups, 蠂 ~ (2 +) ~ (2) (0.344) P _ (0.05). Conclusion NACRT can effectively reduce the volume of tumor and reduce the tumor stage. However, there was no significant improvement in the invasion of CRM. MRI and MSCT could accurately judge the degree of tumor invasion, but the accuracy of MRI in detecting lymph node metastasis was lower than that of MSCT, but there was no significant difference in accuracy.
【作者單位】： 新疆醫(yī)科大學(xué)附屬腫瘤醫(yī)院胃腸外科;
【分類號】：R735.37

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