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目的探讨直肠癌术前应用经直肠超声(transrectal ultrasound,TRUS)评估对于预测保肛与非保肛手术方案选择的价值。方法纳入病理诊断为直肠癌且肿瘤下缘距齿状线≤10cm者49例,记录术前TRUS分期和预计手术方案,与术后病理分期和实际手术方案进行比较。结果TRUS术前评估得到uT分期准确度为91.8%,uN分期准确度为51.2%。Logistic回归分析显示,肿瘤厚度(以13mm为分界点)为保肛手术方案的危险因素(回归系数=2.784,P=0.013)。当同时满足肿瘤厚度≥13mm和uT4期时,行非保肛手术的可能性为41.7%;而当TRUS提示肿瘤厚度<13mm时能成功实施保肛手术的可能性为96.0%。结论运用TRUS对直肠癌患者行术前评估,可以得到肿瘤厚度和uT分期2个影响手术方案的客观指标,为临床医师预测保肛或非保肛手术方案提供依据。
Objective To investigate the value of pretransplant transrectal ultrasound (TRUS) for the prediction of the selection of surgical approaches for anus retention and non-retention anorectal surgery. Methods Forty-nine patients with pathological diagnosis of rectal cancer with a margin of less than 10 cm from the dentate line were enrolled in this study. The preoperative TRUS staging and the anticipated surgical plan were compared with the postoperative pathological staging and the actual operative plan. Results The accuracy of uT staging was 91.8% and the uN staging accuracy was 51.2%. Logistic regression analysis showed that the thickness of the tumor (13mm as a cut-off point) was a risk factor for the anal sphincter preservation procedure (regression coefficient = 2.784, P = 0.013). The probability of non-anal sphincter preservation was 41.7% when both the tumor thickness ≥13 mm and the uT4 phase were satisfied at the same time, and the probability of successful anus-preserving surgery was 96.0% when TRUS suggested a tumor thickness <13 mm. Conclusion The preoperative evaluation of TRUS in patients with rectal cancer can be obtained objective parameters of tumor thickness and uT staging 2 affect the surgical regimen for clinicians to provide the basis for the prediction of anus or non-anus anal surgery program.