摘要
目的探讨内镜超声(EUS)在结直肠癌术前TNM分期中的应用价值。方法对60例手术切除的结直肠癌患者术前行内镜超声检查,术后进行病理检查,将两者对肿瘤侵犯深度的诊断结果进行比较。结果经EUS检查,发现正常结直肠壁表现为5层结构,第1、3、5层表现为高回声,第2、4层表现为低回声。第1、2层为黏膜层,第3层为黏膜下层,第4层为固有肌层,第5层为浆膜下和浆膜层。EUS下结直肠癌表现为低回声肿块,其回声强度介于第3层高回声和第4层低回声之间。根据EUS下结直肠壁5层结构和邻近器官的改变判断肿瘤侵犯的深度,进行TNM分期诊断。肿瘤旁直径大于或等于5mm圆形的低回声病灶诊断为转移性淋巴结。EUS对本组结直肠癌TNM分期诊断总的准确率为85.0%;周围淋巴结转移诊断的敏感性和特异性为54.8%和66.7%。结论EUS对结直肠癌侵犯深度的判断有较高的准确率,对术前TNM分期诊断有一定价值。术前EUS检查可以为结直肠癌治疗选择合适的方案提供指导。
Objective To assess the value of endoscopic ultrasonography (EUS)in the preoperative TNM staging of colorectal carcinoma.Methods Sixty patients with colorectal carcinoma proven pathologically after surgical resection were given EUS before operation. Both data were compared in the diagnosis of depth of the tumor invasion. Results Normal colorectal wall was visualized by EUS as a five layered structure. The first, third and fifth layers were hyperechoic,the second and fourth layers were hypoechoic.The first and second layers comprised the mucosa, the third layer was the submucosa, the fourth layer the muscularis propria,and the fifth layer was the subserosa and serosa(adventitia).Colorectal carcinoma appeared as a hypoechoic mass with an intermediate echo level between the third hyperechoic and the fourth hypoechoic layer. The depth of the tumor invasion and T staging diagnosis were based on the changes of these layer structure and adjacent organs. Metastatic lymph node was defined as pericolonic,hypoechoic mass lesion with a size ≥5 mm in diameter. EUS had an overall accuracy rate of 85.0% in the diagnosis of T staging of colorectal cancer.The sensitivity and specificity of EUS in the diagnosis of lymph node metastasis were 54.8% and 66.7%. Conclusions EUS has a high accuracy in determining the depth of colorectal carcinoma and has some value in preoperative TNM staging. The preoperative EUS may provide much information and the choice of therapy.
出处
《中华胃肠外科杂志》
CAS
2001年第4期237-240,共4页
Chinese Journal of Gastrointestinal Surgery
关键词
内镜超声
结直肠肿瘤
TNM分期
Endoscopic ultrasonography
Colorectal neoplasm
TNM stage
