低位直肠癌Miles术11例临床分析
发布时间：2018-08-11 21:17
【摘要】：目的:研究直肠指诊、直肠腔内超声(ERUS)及3.0T核磁共振(3.0T MRI)在低位直肠癌术前评估中的应用价值,并对经括约肌间切除术(ISR)在低位直肠癌治疗中的合理应用进行初步探讨。方法:以2016年4月至2017年3月在广西医科大学第一附属医院结直肠肛门外科接受Miles术的11例患者为例。术前分别采用直肠指诊、ERUS和MRI三种手段测量肿瘤下缘至括约肌间沟距离,并分别与术后新鲜标本所测得距离进行对比。术前采用ERUS和MRI对直肠癌进行T分期,并分别与术后病理T分期进行比较。对术后标本行组织病理大切片HE染色法以评价肿瘤局部浸润情况。最终,通过综合分析肿瘤远切缘及局部浸润情况,来推断ISR在低位直肠癌的保肛治疗中是否能达到R0切除。结果:1、直肠指诊、ERUS、MRI及术后新鲜标本测得肿瘤下缘到括约肌间沟的距离分别为:(2.25±0.44)cm、(2.86±0.66)cm、(2.52±0.50)cm、(2.21±0.68)cm;其中,ERUS所测得距离和术后标本的距离进行比较,差异有统计学意义(P0.05)。直肠指诊与MRI所测得距离与术后标本的距离进行比较,差异均无统计学意义(均P0.05)。2、术后病理提示:T1期0例,T2期5例,T3期4例,T4期2例。ERUS术前T分期与术后病理符合率为63.6%(7/11),MRI术前T分期与术后病理符合率为72.7%(8/11)。3、术后大切片HE染色结果提示肿瘤局部浸润情况如下:11例均未侵犯括约肌间沟处;未浸润内括约肌者7例,侵及部分内括约肌者4例;未浸润外括约肌者10例,侵及外括约肌者1例;侵及肛提肌者1例。结论:1、相比于ERUS,直肠指诊及3.0T MRI测量低位直肠癌下缘距括约肌间沟距离结果更为可靠。2、ERUS与3.0T MRI在低位直肠癌术前T分期的效果相当。3、对位于齿状线以上的早中期低位直肠癌,特别是对于肿瘤未侵犯肛门外括约肌的患者而言,经过充分的术前评估可考虑行经括约肌间切除术(ISR)。
[Abstract]:Objective: to study the value of digital rectal diagnosis, intrarectal ultrasound (ERUS) and 3.0T MRI in preoperative evaluation of low rectal cancer, and to explore the rational application of (ISR) in the treatment of low rectal cancer after intersphincter resection. Methods: from April 2016 to March 2017, 11 patients underwent Miles in the first affiliated Hospital of Guangxi Medical University. The distance between the lower margin of the tumor and the intersphincter sulcus was measured by digital rectal diagnosis and MRI before operation, and the distance was compared with that measured by fresh specimens after operation. Preoperative T staging of rectal cancer was performed by ERUS and MRI, and compared with postoperative pathological T staging. Histopathological sections were stained with HE staining to evaluate the local invasion of tumor. Finally, by synthetically analyzing the distal margin and local infiltration of the tumor, we infer whether ISR can achieve R0 resection in the anus-preserving therapy of low rectal cancer. Results the distance between the lower margin of the tumor and the sphincter sulcus was (2.25 卤0.44) cm, (卤0.66) cm, (2.52 卤0.50) cm, (2.21 卤0.68) cm, respectively. The distance between rectal digital diagnosis and MRI was compared with that of postoperative specimen. There was no significant difference between them (P0.05). 2. The postoperative pathology showed that 0 cases of stage 1 and 5 cases of stage T 3 of T 2 cases of stage T 4 of T 3 stage, 2 cases of stage T before and after operation of ERUS were 63.6% (7 / 11). The coincidence rate of preoperative T staging with postoperative pathology was 72.7% (8 / 11) .3.The rate of postoperative large section was 72.7% (8 / 11). The results of HE staining showed that the local invasion of tumor was as follows: no invasion of sphincter sulcus was found in all of the 11 cases. Internal sphincter was not infiltrated in 7 cases, partial internal sphincter in 4 cases, external sphincter in 10 cases, external sphincter in 1 case, levator ani muscle in 1 case. Conclusion compared with Erus, rectal digital diagnosis and 3.0T MRI are more reliable than Erus in measuring the distance between lower margin and sphincter of low rectal cancer. 2Erus and 3.0 T MRI have the same effect on preoperative T staging of low rectal cancer. In particular, for patients with tumors that do not invade the external anal sphincter, (ISR). May be considered for transsphincter resection after adequate preoperative evaluation
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37
本文编号：2178259
[Abstract]:Objective: to study the value of digital rectal diagnosis, intrarectal ultrasound (ERUS) and 3.0T MRI in preoperative evaluation of low rectal cancer, and to explore the rational application of (ISR) in the treatment of low rectal cancer after intersphincter resection. Methods: from April 2016 to March 2017, 11 patients underwent Miles in the first affiliated Hospital of Guangxi Medical University. The distance between the lower margin of the tumor and the intersphincter sulcus was measured by digital rectal diagnosis and MRI before operation, and the distance was compared with that measured by fresh specimens after operation. Preoperative T staging of rectal cancer was performed by ERUS and MRI, and compared with postoperative pathological T staging. Histopathological sections were stained with HE staining to evaluate the local invasion of tumor. Finally, by synthetically analyzing the distal margin and local infiltration of the tumor, we infer whether ISR can achieve R0 resection in the anus-preserving therapy of low rectal cancer. Results the distance between the lower margin of the tumor and the sphincter sulcus was (2.25 卤0.44) cm, (卤0.66) cm, (2.52 卤0.50) cm, (2.21 卤0.68) cm, respectively. The distance between rectal digital diagnosis and MRI was compared with that of postoperative specimen. There was no significant difference between them (P0.05). 2. The postoperative pathology showed that 0 cases of stage 1 and 5 cases of stage T 3 of T 2 cases of stage T 4 of T 3 stage, 2 cases of stage T before and after operation of ERUS were 63.6% (7 / 11). The coincidence rate of preoperative T staging with postoperative pathology was 72.7% (8 / 11) .3.The rate of postoperative large section was 72.7% (8 / 11). The results of HE staining showed that the local invasion of tumor was as follows: no invasion of sphincter sulcus was found in all of the 11 cases. Internal sphincter was not infiltrated in 7 cases, partial internal sphincter in 4 cases, external sphincter in 10 cases, external sphincter in 1 case, levator ani muscle in 1 case. Conclusion compared with Erus, rectal digital diagnosis and 3.0T MRI are more reliable than Erus in measuring the distance between lower margin and sphincter of low rectal cancer. 2Erus and 3.0 T MRI have the same effect on preoperative T staging of low rectal cancer. In particular, for patients with tumors that do not invade the external anal sphincter, (ISR). May be considered for transsphincter resection after adequate preoperative evaluation
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37
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1 林天松;低位直肠癌Miles术11例临床分析[D];广西医科大学;2017年
，本文编号：2178259
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