發(fā)布時(shí)間：2019-01-24 14:32

【摘要】：目的:探討MRI在直腸癌術(shù)前T分期中的應(yīng)用價(jià)值。方法:收集吉林大學(xué)中日聯(lián)誼醫(yī)院胃腸結(jié)直腸肛門外科自2014年9月至2015年12月收治的138例原發(fā)性直腸癌患者,所有患者均在手術(shù)前行電子纖維結(jié)腸鏡檢查并經(jīng)病理診斷為直腸癌,且在MRI檢查后1至6天內(nèi)行手術(shù)治療并進(jìn)行術(shù)后病理學(xué)檢查,均在全直腸系膜切除術(shù)(TME)的原則下行直腸癌根治術(shù),手術(shù)分為腹腔鏡手術(shù)和傳統(tǒng)開(kāi)腹手術(shù),手術(shù)方式包括經(jīng)腹直腸癌前切除術(shù)(Dixon)和經(jīng)腹會(huì)陰聯(lián)合直腸癌根治術(shù)(Miles)。術(shù)后切除的標(biāo)本均在半小時(shí)內(nèi)福爾馬林浸泡固定,由兩名經(jīng)驗(yàn)豐富的病理科醫(yī)生觀察判斷,MRI圖像均有兩名高年資的放射線醫(yī)生分別獨(dú)立閱片。其中男性患者共計(jì)72例(52.17%),女性患者共計(jì)66例(47.83%),年齡在30至90歲之間,平均年齡58.60歲。以直腸癌術(shù)后病理分期結(jié)果為標(biāo)準(zhǔn),評(píng)估術(shù)前MRI對(duì)T分期的準(zhǔn)確性及腫瘤與腹膜返折位置關(guān)系的影響。結(jié)果:所有患者經(jīng)MRI術(shù)前T分期結(jié)果:T1期4例,T2期24例,T3期102例,T4期8例。術(shù)后病理學(xué)分期T分期結(jié)果:T1期6例,T2期30例,T3期98例,T4期4例。在所有138例直腸癌患者中,術(shù)前MRI T分期與術(shù)后病理T分期結(jié)果一致的有108例,總體準(zhǔn)確率為78.26%,其中T1期準(zhǔn)確率66.67%(4/6),T2期準(zhǔn)確率為46.67%(14/30),T3期準(zhǔn)確率為87.76%(86/98),T4期準(zhǔn)確率為100.00%(4/4);術(shù)前MRI T分期與術(shù)后病理學(xué)T分期不一致的有30例,其中過(guò)低分期的有8例(26.67%),過(guò)度分期的有22例(73.33%)。術(shù)前MRI T分期和病理T分期的一致性檢驗(yàn)結(jié)果:Kappa=0.500,兩者一致性較好。腫瘤位于腹膜返折以上的病例共有35例,其中術(shù)前MRI T分期與術(shù)后病理T分期結(jié)果一致的有29個(gè)病例,準(zhǔn)確率為82.86%。位于腹膜返折以下的病例有103例,其中術(shù)前MRI T分期與術(shù)后病理T分期結(jié)果一致的有79個(gè)病例,準(zhǔn)確率為76.70%。兩者差異無(wú)統(tǒng)計(jì)學(xué)意義(X2=1.106,p0.05)。結(jié)論:MRI對(duì)直腸癌術(shù)前T分期與病理學(xué)T分期之間一致性較好,對(duì)直腸癌特別是進(jìn)展期直腸癌的T分期有較高的應(yīng)用價(jià)值,可用于指導(dǎo)臨床治療,其應(yīng)用不受腫瘤與腹膜返折位置關(guān)系的影響。
[Abstract]:Objective: to evaluate the value of MRI in preoperative T staging of rectal cancer. Methods: a total of 138 patients with primary rectal cancer admitted from September 2014 to December 2015 in the Sino-Japanese Friendship Hospital of Jilin University were collected. All the patients were diagnosed as rectal cancer by electronic fiberoptic colonoscopy before operation and diagnosed by pathology. All patients were treated with operation within 1 to 6 days after MRI examination and underwent postoperative pathological examination. Radical resection of rectal cancer was performed on the principle of total mesorectal excision (TME). The operation was divided into laparoscopic surgery and traditional open operation. The operative methods included anterior transabdominal resection of rectal cancer (Dixon) and transabdominal perineum combined radical resection of rectal cancer (Miles). The specimens were soaked and fixed in formalin within half an hour after operation. According to the observation of two experienced pathologists, two radiographers with high seniority read the films independently on MRI images. There were 72 cases (52.17%) of male patients and 66 cases (47.83%) of female patients, aged between 30 and 90 years with an average age of 58.60 years. To evaluate the effect of preoperative MRI on the accuracy of T staging and the relationship between tumor and peritoneal reflexes according to postoperative pathological staging of rectal cancer. Results: the results of T staging before MRI were as follows: T1 4 cases, T2 24 cases, T3 102 cases, T4 8 cases. Postoperative pathological staging and T staging: T1 6 cases, T2 30 cases, T3 98 cases, T4 4 cases. Among the 138 patients with rectal cancer, 108 cases had the same results of preoperative MRI T staging and postoperative pathological T staging, the overall accuracy was 78.26, and the T1 stage accuracy rate was 66.67% (4 / 6). The accuracy of T2, T3 and T4 was 46.67% (14 / 30), 87.76% (86 / 98) and 100.00% (4 / 4), respectively. The preoperative MRI T staging was inconsistent with postoperative pathological T staging in 30 cases, including 8 cases (26.67%) with too low staging and 22 cases (73.33%) with excessive staging. Preoperative MRI T staging and pathological T staging consistency test results: Kappa=0.500, and good consistency. There were 35 cases with tumor located above peritoneal reflex. 29 cases with preoperative MRI T staging were consistent with postoperative pathological T staging, and the accuracy was 82.86%. There were 103 cases located below peritoneal reflux, of which 79 cases had the same results of preoperative MRI T staging and postoperative pathological T staging, and the accuracy was 76.707.00%. There was no significant difference between the two groups (X _ 2: 1.106 p 0.05). Conclusion: MRI has a good consistency between preoperative T staging and pathological T staging in rectal cancer, and has a high value in the application of T staging in rectal cancer, especially in advanced rectal cancer, and can be used to guide clinical treatment. Its application is not affected by the location of tumor and peritoneal refraction.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.37

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