MRI在直肠癌术前T分期中的应用价值的分析

发布时间：2019-01-24 14:32

【摘要】：目的:探讨MRI在直肠癌术前T分期中的应用价值。方法:收集吉林大学中日联谊医院胃肠结直肠肛门外科自2014年9月至2015年12月收治的138例原发性直肠癌患者,所有患者均在手术前行电子纤维结肠镜检查并经病理诊断为直肠癌,且在MRI检查后1至6天内行手术治疗并进行术后病理学检查,均在全直肠系膜切除术(TME)的原则下行直肠癌根治术,手术分为腹腔镜手术和传统开腹手术,手术方式包括经腹直肠癌前切除术(Dixon)和经腹会阴联合直肠癌根治术(Miles)。术后切除的标本均在半小时内福尔马林浸泡固定,由两名经验丰富的病理科医生观察判断,MRI图像均有两名高年资的放射线医生分别独立阅片。其中男性患者共计72例(52.17%),女性患者共计66例(47.83%),年龄在30至90岁之间,平均年龄58.60岁。以直肠癌术后病理分期结果为标准,评估术前MRI对T分期的准确性及肿瘤与腹膜返折位置关系的影响。结果:所有患者经MRI术前T分期结果:T1期4例,T2期24例,T3期102例,T4期8例。术后病理学分期T分期结果:T1期6例,T2期30例,T3期98例,T4期4例。在所有138例直肠癌患者中,术前MRI T分期与术后病理T分期结果一致的有108例,总体准确率为78.26%,其中T1期准确率66.67%(4/6),T2期准确率为46.67%(14/30),T3期准确率为87.76%(86/98),T4期准确率为100.00%(4/4);术前MRI T分期与术后病理学T分期不一致的有30例,其中过低分期的有8例(26.67%),过度分期的有22例(73.33%)。术前MRI T分期和病理T分期的一致性检验结果:Kappa=0.500,两者一致性较好。肿瘤位于腹膜返折以上的病例共有35例,其中术前MRI T分期与术后病理T分期结果一致的有29个病例,准确率为82.86%。位于腹膜返折以下的病例有103例,其中术前MRI T分期与术后病理T分期结果一致的有79个病例,准确率为76.70%。两者差异无统计学意义(X2=1.106,p0.05)。结论:MRI对直肠癌术前T分期与病理学T分期之间一致性较好,对直肠癌特别是进展期直肠癌的T分期有较高的应用价值,可用于指导临床治疗,其应用不受肿瘤与腹膜返折位置关系的影响。
[Abstract]:Objective: to evaluate the value of MRI in preoperative T staging of rectal cancer. Methods: a total of 138 patients with primary rectal cancer admitted from September 2014 to December 2015 in the Sino-Japanese Friendship Hospital of Jilin University were collected. All the patients were diagnosed as rectal cancer by electronic fiberoptic colonoscopy before operation and diagnosed by pathology. All patients were treated with operation within 1 to 6 days after MRI examination and underwent postoperative pathological examination. Radical resection of rectal cancer was performed on the principle of total mesorectal excision (TME). The operation was divided into laparoscopic surgery and traditional open operation. The operative methods included anterior transabdominal resection of rectal cancer (Dixon) and transabdominal perineum combined radical resection of rectal cancer (Miles). The specimens were soaked and fixed in formalin within half an hour after operation. According to the observation of two experienced pathologists, two radiographers with high seniority read the films independently on MRI images. There were 72 cases (52.17%) of male patients and 66 cases (47.83%) of female patients, aged between 30 and 90 years with an average age of 58.60 years. To evaluate the effect of preoperative MRI on the accuracy of T staging and the relationship between tumor and peritoneal reflexes according to postoperative pathological staging of rectal cancer. Results: the results of T staging before MRI were as follows: T1 4 cases, T2 24 cases, T3 102 cases, T4 8 cases. Postoperative pathological staging and T staging: T1 6 cases, T2 30 cases, T3 98 cases, T4 4 cases. Among the 138 patients with rectal cancer, 108 cases had the same results of preoperative MRI T staging and postoperative pathological T staging, the overall accuracy was 78.26, and the T1 stage accuracy rate was 66.67% (4 / 6). The accuracy of T2, T3 and T4 was 46.67% (14 / 30), 87.76% (86 / 98) and 100.00% (4 / 4), respectively. The preoperative MRI T staging was inconsistent with postoperative pathological T staging in 30 cases, including 8 cases (26.67%) with too low staging and 22 cases (73.33%) with excessive staging. Preoperative MRI T staging and pathological T staging consistency test results: Kappa=0.500, and good consistency. There were 35 cases with tumor located above peritoneal reflex. 29 cases with preoperative MRI T staging were consistent with postoperative pathological T staging, and the accuracy was 82.86%. There were 103 cases located below peritoneal reflux, of which 79 cases had the same results of preoperative MRI T staging and postoperative pathological T staging, and the accuracy was 76.707.00%. There was no significant difference between the two groups (X _ 2: 1.106 p 0.05). Conclusion: MRI has a good consistency between preoperative T staging and pathological T staging in rectal cancer, and has a high value in the application of T staging in rectal cancer, especially in advanced rectal cancer, and can be used to guide clinical treatment. Its application is not affected by the location of tumor and peritoneal refraction.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

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