【摘要】 目的探讨经直肠腔内灌注肠道超声造影在结直肠占位性病变中的诊断价值。方法选取可疑结直肠占位性病变的患者196例,每例患者分别接受经直肠腔内灌注超声造影检查和肠道内窥镜检查。以外科手术病理结果作为"金标准",分析比较经直肠腔内灌注超声造影检查和肠道内窥镜检查诊断结直肠占位性病变的准确性。结果经直肠腔内灌注超声造影观察结肠和直肠的解剖结构和病变特征,发现恶性占位性病变81例,其中结肠癌39例,直肠癌42例;良性占位性病变30例,其中直肠息肉11例,结肠息肉19例。经直肠腔内灌注超声造影探查结直肠占位性病变的位置、数目和>10 mm的病变,其敏感度、特异度、阳性预测值、阴性预测值和准确性,与肠道内窥镜检查比较,均无显著差异。经直肠腔内灌注超声造影检查与肠道内窥镜检查在判断病变位置和数目方面均具有良好的一致性(K值=0.97,0.98)。两者在判断结直肠占位性病变大小方面的一致性因病变大小而不同:对于<5 mm、5～10 mm、> 10 mm的结直肠占位性病变的探查,两种检查方法的一致性K值分别为0.82,0.89,0.98,其敏感度、特异度、阳性预测值、阴性预测值和准确性结果也显示在探查微小的(<5 mm)黏膜病变时,肠道内窥镜检查略优于经直肠腔内灌注超声造影检查。在探查经手术证实的周围组织浸润病变时,经直肠腔内灌注超声造影检查明显优于肠道内窥镜检查。结论经直肠腔内灌注超声造影检查可以有效探查结直肠占位性病变的位置和范围,与肠道内窥镜检查互补性强,其可作为结直肠占位性病变的常规检查方法之一。更多还原

【Abstract】 Objective To evaluate the reliability of intrarectal contrast-enhanced ultrasonography in the detection of colorectal space-occupying lesions. Methods One hundred and ninety-six consecutive patients with suspected colonic and rectal lesions(colorectal cancer or colorectal polyps), who had undergone intrarectal contrast-enhanced ultrasonography and endoscopic evaluation, were enrolled in the study. Each examination was performed independently by two operators. Using surgical pathological findings as the gold standard, the accuracy of intrarectal contrast-enhanced ultrasonography was determined and compared with intestinal endoscopy. Results After intrarectal contrast administration, the anatomy of the colon and rectum as well as the morphologic features of the lesions in these locations were clearly visualized. There were 81 cases of malignant lesions including colon cancer(n=39) and rectal cancer(n=42), and 30 cases of benign lesions including rectal polyps(n=11) and colonic polyps(n=19). The sensitivities, specificities, positive predictive values, negative predictive values and accuracies of intrarectal contrast-enhanced ultrasonography in detecting lesion site, size( > 10 mm), number, and extents were similar to those of intestinal endoscopy. Moreover, intrarectal contrast-enhanced ultrasonography was far better than intestinal endoscopy in detecting adjacent structure abnormalities as identified at surgical pathology. However, intrarectal contrast-enhanced ultrasonography was a bit poorer than intestinal endoscopy in detecting minor mucosal abnormalities( < 5 mm). Conclusions Intrarectal contrast-enhanced ultrasonography can effectively define the anatomic location and extension of colorectal space-occupying lesions, whose diagnostic performance is not worse than intestinal endoscopy. It can be used as a routine examination method for colorectal space-occupying lesions.更多还原