【摘要】：目的:研究直腸指診、直腸腔內(nèi)超聲(ERUS)及3.0T核磁共振(3.0T MRI)在低位直腸癌術(shù)前評估中的應(yīng)用價值,并對經(jīng)括約肌間切除術(shù)(ISR)在低位直腸癌治療中的合理應(yīng)用進行初步探討。方法:以2016年4月至2017年3月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院結(jié)直腸肛門外科接受Miles術(shù)的11例患者為例。術(shù)前分別采用直腸指診、ERUS和MRI三種手段測量腫瘤下緣至括約肌間溝距離,并分別與術(shù)后新鮮標(biāo)本所測得距離進行對比。術(shù)前采用ERUS和MRI對直腸癌進行T分期,并分別與術(shù)后病理T分期進行比較。對術(shù)后標(biāo)本行組織病理大切片HE染色法以評價腫瘤局部浸潤情況。最終,通過綜合分析腫瘤遠切緣及局部浸潤情況,來推斷ISR在低位直腸癌的保肛治療中是否能達到R0切除。結(jié)果:1、直腸指診、ERUS、MRI及術(shù)后新鮮標(biāo)本測得腫瘤下緣到括約肌間溝的距離分別為:(2.25±0.44)cm、(2.86±0.66)cm、(2.52±0.50)cm、(2.21±0.68)cm;其中,ERUS所測得距離和術(shù)后標(biāo)本的距離進行比較,差異有統(tǒng)計學(xué)意義(P0.05)。直腸指診與MRI所測得距離與術(shù)后標(biāo)本的距離進行比較,差異均無統(tǒng)計學(xué)意義(均P0.05)。2、術(shù)后病理提示:T1期0例,T2期5例,T3期4例,T4期2例。ERUS術(shù)前T分期與術(shù)后病理符合率為63.6%(7/11),MRI術(shù)前T分期與術(shù)后病理符合率為72.7%(8/11)。3、術(shù)后大切片HE染色結(jié)果提示腫瘤局部浸潤情況如下:11例均未侵犯括約肌間溝處;未浸潤內(nèi)括約肌者7例,侵及部分內(nèi)括約肌者4例;未浸潤外括約肌者10例,侵及外括約肌者1例;侵及肛提肌者1例。結(jié)論:1、相比于ERUS,直腸指診及3.0T MRI測量低位直腸癌下緣距括約肌間溝距離結(jié)果更為可靠。2、ERUS與3.0T MRI在低位直腸癌術(shù)前T分期的效果相當(dāng)。3、對位于齒狀線以上的早中期低位直腸癌,特別是對于腫瘤未侵犯肛門外括約肌的患者而言,經(jīng)過充分的術(shù)前評估可考慮行經(jīng)括約肌間切除術(shù)(ISR)。
[Abstract]:Objective: to study the value of digital rectal diagnosis, intrarectal ultrasound (ERUS) and 3.0T MRI in preoperative evaluation of low rectal cancer, and to explore the rational application of (ISR) in the treatment of low rectal cancer after intersphincter resection. Methods: from April 2016 to March 2017, 11 patients underwent Miles in the first affiliated Hospital of Guangxi Medical University. The distance between the lower margin of the tumor and the intersphincter sulcus was measured by digital rectal diagnosis and MRI before operation, and the distance was compared with that measured by fresh specimens after operation. Preoperative T staging of rectal cancer was performed by ERUS and MRI, and compared with postoperative pathological T staging. Histopathological sections were stained with HE staining to evaluate the local invasion of tumor. Finally, by synthetically analyzing the distal margin and local infiltration of the tumor, we infer whether ISR can achieve R0 resection in the anus-preserving therapy of low rectal cancer. Results the distance between the lower margin of the tumor and the sphincter sulcus was (2.25 鹵0.44) cm, (鹵0.66) cm, (2.52 鹵0.50) cm, (2.21 鹵0.68) cm, respectively. The distance between rectal digital diagnosis and MRI was compared with that of postoperative specimen. There was no significant difference between them (P0.05). 2. The postoperative pathology showed that 0 cases of stage 1 and 5 cases of stage T 3 of T 2 cases of stage T 4 of T 3 stage, 2 cases of stage T before and after operation of ERUS were 63.6% (7 / 11). The coincidence rate of preoperative T staging with postoperative pathology was 72.7% (8 / 11) .3.The rate of postoperative large section was 72.7% (8 / 11). The results of HE staining showed that the local invasion of tumor was as follows: no invasion of sphincter sulcus was found in all of the 11 cases. Internal sphincter was not infiltrated in 7 cases, partial internal sphincter in 4 cases, external sphincter in 10 cases, external sphincter in 1 case, levator ani muscle in 1 case. Conclusion compared with Erus, rectal digital diagnosis and 3.0T MRI are more reliable than Erus in measuring the distance between lower margin and sphincter of low rectal cancer. 2Erus and 3.0 T MRI have the same effect on preoperative T staging of low rectal cancer. In particular, for patients with tumors that do not invade the external anal sphincter, (ISR). May be considered for transsphincter resection after adequate preoperative evaluation
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.37

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1 林天松;低位直腸癌Miles術(shù)11例臨床分析[D];廣西醫(yī)科大學(xué);2017年

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