【摘要】 目的探讨腔内超声(endoscopic ultrasonography,EUS)在直肠癌侵犯深度和周围淋巴结转移术前诊断中的应用价值.方法对60例经肠镜活检且拟行手术切除的直肠癌患者行术前腔内超声检查.参照TNM分期标准,结合CT表现,进行术前分期诊断,并与手术及病理分期对照.了解直肠癌腔内超声分期的敏感性及准确性.通过肠镜采取活体组织做病理切片检查,可以确定肿瘤的性质和分化程度.经EUS检查发现正常肠壁表现为5层结构,根据直肠壁5层结构及邻近器官的改变判断肿瘤侵犯的深度.肿瘤旁直径≥5mm圆形或类圆形的低回声病灶诊断为转移性淋巴结.结果直肠癌患者行术前腔内彩色多普勒超声检查,同时结合肠镜、CT检查,并与术后病理结果比较,肠镜在直肠癌的术前确诊、定位及定性与术中所见及术后诊断基本相符.EUS结合CT表现对直肠癌侵犯深度的诊断有很高的准确性,对直肠癌术前TNM或Dukse分期有一定的价值.术前EUS结合肠镜、CT检查可以为直肠癌选择合适的治疗方案提供指导.结论腔内彩色多普勒超声结合肠镜、CT检查对直肠癌术前分期诊断有重要作用.更多还原

【Abstract】 Objective To explore the application value of endoscopic ultrasonography in preoperative diagnosis of rectal carcinoma invasion depth and PLN transfer. Methods 60 patients of rectal cancer, who had been examined by enteroscopic biopsy and planed to undergo rectectomy, had endoluminal ultrasonic examination, according to TNM classification criteria combined with CT presentation. They were classified and preoperative staging diagnosis was performed at the same time, then the results were compared with the operation and the pathological classification to find out the sensitivity and accuracy of the endoluminal ultrasonic staging for rectal cancer. We could define the property and differentiation of the tumor through pathological section attained through enteroscope. In EUS carcinoma of rectum displayed low level of echo lump and the echo intensity was between the third high-level echo and the fourth low-level echo. According to the 5-layer structure of rectum and the alteration of adjacent organs, the depth of invasion could be judged. The low-level echo lump with the diameter≥5 mm and the shape of round or similar round could be diagnosed metastatic LN. Results The rectal cancer patients were all performed EUS, colonoscopy and CT scan, then the results were compared with those of operation and the pathology. The preoperative confirmed diagnosis, location and qualitification of rectal cancer by colonoscopy corresponded to the evidence during the operation and the final diagnosis after operation. EUS combined with CT manifestation was highly accurate in the diagnosis of the depth of invasion of rectal cancer, and was valuable to the TNM or Duke Staging. The EUS combined with colonoscopy and CT provided instruction with proper treatment plan for the patients. Conclusion Endoscopic color Doppler ultrasonography, combined enteroscope and CT-scopy plays an important role in the preoperative staging diagnosis for rectal cancer.更多还原