【作者】 刘瑞宝； 申宝忠； 杨光； 于树江； 韩金生； 刘国军； 董军； 郭晓梅；

【Author】 Liu ruibao Shen baozhong Yu shujiang The third clinical college of Harbin Medical university P. R. China 150040 Li Jianjun The Traditional Chinese medicine College of Heilongjiang Han Jinsheng Liu Goujun Hulin people’s hospital of Heilongjiang provence 158300

【机构】 哈尔滨医科大学第三临床医学院； 虎林市人民医院； 密山市人民医院；

【摘要】 目的探讨CT无明显复发征象的直肠癌Mile’s术后男性病人的血管造影表现,评价局部动脉灌注化疗对直肠癌术后局部复发的价值。方法对10例CT无明显复发征象的直肠癌 Mile’s术后病人,采用Seldinger法选入靶血管行造影及局部动脉灌注化疗。结果直肠癌局部复发血管造影表现为:动脉期靶血管增粗、扭曲,分枝增多(8／10),肿瘤血管排列紊乱(5／10),动静脉瘘(1／10)。实质期:肿瘤染色(8／10),其范围及形态与CT图像相符。10例病人临床症状均有缓解, 6例行二次手术治疗。结论:对于直肠癌术后复发诊断应以定期CT复查为主。对CT无明显复发征象者,可行血管造影明确诊断。直肠癌术后复发局部化疗对杀灭肿瘤,抑制病变生长,控制转移有作用,杀灭隐匿病灶可为二次手术及综合治疗提供基础。更多还原

【Abstract】 Purpose To propose a new preperative CT staging method for primary rectal carcinoma and evaluate it’s value. Material and method : 81 consecutive cases with biopsy proven rectal carcino- ma were examed by CT before surgery. The diagnose of invasive depth and the staging were de- termined for all cases without knowledge of histologic results, accorading to the outer ringe of the tumor and whether it has enlarge Lympic nodes, distal organs metastasis. Then we correlated them with pathologic findings. Result: The invasive deptb were correctly diagnosed as muscular layer in 24 of 38 patients, as serous coat in 38 of 43 patients. The overall accuracy was 76.5%. On the basis of our staging criteria comparison of CT and histologic results (following the modi- fied Dukes classification) showed that disease was correctly staged as A in 17 of 29, as B in 28 of 31, as C in 11 of 15 and D in 3 of 6. The overall staging accurcy was 72.8%. Conclusion: 1. The outer ringe of the tumor has a close relation to the depth that the disease involed the bowelwall, perirectal tissre and adjacent organs. (1) Smooth. It is an important feature that indicate the dis- ease within the muscular layer. (P less than 0.01). (2) Speculated appearance, Twining string sign. Small soft tissue densities strands that extend direct from the adjacent tumor are a charac- teristic sign that indicate tumor extension (P＜0.01). 2. Enlarge, or more than three normal size melted nodes are considered to be metastatic ones. 3. CT could not be used as a primary examia- tion method in workup of patients with suspected rectal cancer. The staging method we proposed has an important clinical significance.更多还原