螺旋CT扫描对结直肠癌术前分期的探讨

目的:评估螺旋CT扫描(Spiral CT;SCT)对结直肠癌术前分期的诊断价值及限度。方法:对68例经结肠气钡双对比造影和电子结肠镜活检证实的结直肠癌病人,术前行螺旋CT扫描,进行螺旋CT术前TNM和Duke分期,然后与术中、术后病理各分期一一对照。结果:螺旋CT双期扫描显示结直肠癌的敏感性达98.5％(67/68);对结直肠癌TNM分期的准确率83.8％(57/68),Duke分期的准确率为86.7％(59/68),较文献报道的普通CT扫描的50％有明显提高。其中T分期,螺旋CT诊断的正确率为88.2％(60/68);N分期为83.8％(57/68),5例有肝转移的病人螺旋CT均正确诊断。结论:充分的扫描前肠管准备和良好的扫描方法是螺旋CT时结直肠癌准确分期的关键;螺旋CT扫描对结直肠癌术前分期很有价值,是目前临床评价结直肠癌术前分期的最有效检查方法之一;螺旋CT扫描时结直肠癌的T分期存在一定限度,对于微小淋巴结转移以及远处微小或潜在转移的诊断尚有一定困难。

The Preoperative Staging of the Colorectal Carcinoma with Spiral CT

Objective To determine the diagnostic value and limitation of Spiral CT(SCT) in staging of the colorectal carcinoma. Methods Sixty-eight patients of rectum or colon carcinoma with histological proven were included in this study. All of them were the preoperative staged in TNM and Duke by SCT examination. The results of SCT were compared with those of surgical and pathological examination in all cases. Result 67 cases in all patients were demonstrated clearly by SCT and the rate of sensitivity is 98. 5 % ; 57cases of 68 patients correctly in TNM staging and 59 cases in Duke .the rates of accuracy are 83. 8% and 86. 7 % respectively .compared to the overall 50 % accuracy reported by references , The accuracy of SCT is much higher. The diagnostic accuracy of SCT in T and N stage are 88. 2 % (60/68) and 83. 8 %(57 -68) respectively. Five cases with liver convey cancer in M stage were all diagnosed correctly. Conclusion The key of staging of the colorectal carcinoma with spiral CT are enough intestinal prepare before scan and good method of scan. The SCT scan is a better method for depicting the colorectal carcinoma . It allows for accurate depiction and staging of colorectal carcinoma . It is one of the best image method for staging the colorectal carcinoma. However the usage of SCT for early T staging colorectal carcinoma and minuteness metastasis of lymph nodes and liver are limited.