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目的探讨直肠内充气MSCT检查在直肠癌术前肠系膜浸润及淋巴结转移分期中的临床诊断价值。方法选择2010年1月至2010年7月期间辽宁医学院附属第一医院68例经手术病理证实的直肠癌患者,术前行直肠内充气MSCT检查,以术后病理结果作为金标准,比较直肠内充气MSCT在诊断肠系膜浸润及淋巴结转移方面的准确性、敏感度、特异度、阳性预测值及阴性预测值。结果直肠内充气MSCT扫描患者的直肠及乙状结肠充分扩张,直肠周围脂肪间隙与相对较高密度的肠壁及极低密度肠腔对比清晰。直肠内充气MSCT对直肠癌肠系膜浸润Ⅰ、Ⅱ、Ⅲ度的准确性分别为92.6(63/68)、91.1%(62/68)及95.6%(65/68),敏感度分别为91.2%(31/34)、85.0%(17/20)及92.9%(13/14),特异度分别为94.1%(32/34)、93.8%(45/48)及96.3%(52/54),阳性预测值分别为93.9%(31/33)、85.0%(17/20)及86.7%(13/15),阴性预测值分别为91.4%(32/35)、93.8%(45/48)及98.1%(52/53);直肠癌肠系膜淋巴结转移N0、N1、N2分期的准确性分别为92.6%(63/68)、85.3%(58/68)及92.6%(63/68),敏感度分别为86.2%(25/29)、90.0%(27/30)及66.7%(6/9),特异度分别为97.4%(38/39)、81.6%(31/38)及96.6%(57/59),阳性预测值分别为96.2%(25/26)、79.4%(27/34)及75.0%(6/8),阴性预测值分别为90.5%(38/42)、92.1%(35/38)及95.0%(57/60)。结论直肠内充气MSCT扫描能够清晰显示直肠癌直肠系膜浸润深度,对肠系膜淋巴结转移术前N分期诊断与病理N分期具有较高的敏感度和特异度,在直肠癌术前分期中有重要的应用价值,可作为术前影像学评估的常规手段,为制定个体化的治疗方案提供指导。
Objective To investigate the clinical value of intrarectal inflatable MSCT in preoperative mesenteric invasion and lymph node metastasis. Methods From January 2010 to July 2010, 68 patients with pathologically confirmed rectal cancer in the First Affiliated Hospital of Liaoning Medical College were enrolled in this study. The patients underwent rectal gastroscopy with MSCT preoperatively and the postoperative pathological results as the gold standard. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of inflatable MSCT in the diagnosis of mesenteric invasion and lymph node metastasis. Results The rectum and sigmoid colon were fully expanded in patients undergoing rectal inflatable MSCT scan. The periprosthetic fat space was clearly compared with the relatively high density intestinal wall and very low density intestine. The accuracy of rectal infiltrating MSCT in mesenteric invasion of rectal cancer was 92.6 (63/68), 91.1% (62/68) and 95.6% (65/68), respectively, with the sensitivity of 91.2% The positive rates were 94.1% (32/34), 93.8% (45/48) and 96.3% (52/54) respectively, with a positive rate of 85.0% (17/20) and 92.9% (13/14) The predicted values were 93.9% (31/33), 85.0% (17/20) and 86.7% (13/15) respectively, and the negative predictive values were 91.4% (32/35), 93.8% (45/48) and 98.1 % (52/53). The accuracy of staging in mesenteric lymph node metastasis of rectal cancer was 92.6% (63/68), 85.3% (58/68) and 92.6% (63/68), respectively The positive rates were 86.2% (25/29), 90.0% (27/30) and 66.7% (6/9) respectively, and the specificity were 97.4% (38/39), 81.6% (31/38) and 96.6% The positive predictive value was 96.2% (25/26), 79.4% (27/34) and 75.0% (6/8) respectively. The negative predictive value was 90.5% (38/42) and 92.1% 38) and 95.0% (57/60). Conclusions Rectal inflamed MSCT scan can clearly show the depth of mesorectum in rectal cancer. It has high sensitivity and specificity for preoperative diagnosis of N stage and pathological N stage in mesenteric lymph node metastasis. It has an important application in the preoperative staging of rectal cancer Value, as a preoperative imaging assessment of conventional means, to develop individualized treatment programs to provide guidance.