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目的 探讨腔内超声对确定直肠癌病灶边界及直肠远端手术切缘的意义。方法 应用高频腔内超声探头 ,对 33例直肠癌标本在腔内超声引导下确定直肠远端切缘 ,与病理组织学结果对照。用聚合酶链反应 单链构象多态性分析 (polymerasechainreation singlestrandconformationpolymorphism ,PCR SSCP)方法 ,以p5 3、K ras基因突变作为肿瘤分子标志物 ,检测切缘残余癌细胞。结果 33例腔内超声探测结果 ,对直肠癌浸润深度判断的准确性为 86 6 % ,其中对黏膜、黏膜下浸润病变的准确性为 72 7% ,对肌层浸润的准确性为 90 9% ,对外膜、直肠周围组织受侵的准确性分别为88 5 %、10 0 %。在腔内超声确定病灶边界远端肠段 1 0、2 0、3 0cm切缘病理组织学检查均未见残留癌细胞 ,PCR SSCP未检测到残留癌细胞突变基因分子标志。结论 腔内超声对直肠癌病灶边界的显示与病理组织学检查结果更为接近 ,经直肠腔内超声对术中确定直肠远端切缘较为准确、安全。
Objective To investigate the significance of endoscopic ultrasonography in determining the margins of rectal cancer lesions and distal rectal surgeries. Methods High-frequency intracavitary ultrasound probe was used to determine the distal rectal margin of 33 cases of rectal cancer under the guidance of intracavitary ultrasound, which was compared with the histopathological results. The mutation of p5 3 and K ras gene was used as tumor molecular markers by polymerase chain reaction single strand conformation polymorphism (PCR SSCP) method to detect the residual cancer cells on the margin. Results 33 cases of endoscopic ultrasound findings, the depth of invasion of rectal cancer to determine the accuracy of 86.6%, of which mucosa, submucous infiltration of the accuracy of 72.7%, the accuracy of myometrial invasion was 90 9% The accuracy of invasion to the outer membrane and peri-rectal tissue was 88.5% and 100% respectively. No residual cancer cells were detected by pathologic examination at the 10, 20, 30 cm distal margins in the distal intestine of the lesion, and no SSR markers were detected by PCR SSCP. Conclusion The findings of intracavitary ultrasonography on the border of rectal cancer are more similar to histopathological findings. Transrectal endoscopic ultrasonography is more accurate and safe in determining the distal rectal edge of the rectum.