WJCR  >> Vol. 3 No. 4 (October 2013)

    Clinical Value of Measuring the CT Value of Mesorectum in Preoperative Staging of Middle and Lower Rectal Cancer

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陈晓曦,欧阳书睿,郭睿,林峰洋,张玉龙,谭书文,杨 烈,周总光:四川大学华西医院胃肠外科,成都;

直肠癌体层摄影术X线计算机术前分期Rectal Carcinoma; Tomography; X-Ray Computed; Preoperative Staging


目的:本研究通过测量不同T、N分期直肠癌患者直肠系膜的平均CT衰减值,以寻求直肠癌CT术前T、N分期新的参考指征。方法:纳入2010年9月至2012年9月在四川大学华西医院胃肠外科行手术治疗的直肠中下段腺癌病人123例,术前均采用64排MSCT行全腹部及盆部增强扫描。在每例患者的CT上选取3个癌肿平面,每个平面的直肠系膜上选取6个椭圆形ROI测量CT衰减值,并计算出直肠系膜的平均CT衰减值,然后将不同T、N分期的直肠系膜平均CT衰减值进行相关分析及对比。结果:直肠系膜的平均CT衰减值与直肠癌T分期正相关(rs = 0.439,P < 0.001),但是除T4期高于T1-3期并有统计学意义外(P均 < 0.05),T1、T2、T3期两两间的差异没有统计学意义(P均 > 0.05);直肠系膜的平均CT衰减值与N分期没有相关关系(rs = 0.030, P = 0.740),N0、N1、N2期两两间的差异没有统计学意义(P均 > 0.05)。结论:直肠系膜CT衰减值可为鉴别中下段直肠癌是否侵出直肠系膜提供重要的辅助指标。 

To find a new method for preoperative CT staging in rectal cancer by measuring the mean CT value of mesorectum in patients with different T, N stages. Methods: 123 patients who were diagnosed with middle or lower rectal adenocarcinoma and accepted surgery during September 2010 to September 2012 in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University were enrolled. Contrast-enhanced 64-slice spiral CT examination of the abdomen and pelvis was performed before operation. In every patient, 3 planes of tumor were selected on CT. On each plane, 6 elliptical ROIs were selected within the mesorectum and the CT value of each ROI was measured. Then the mean CT value of mesorectum was calculated. The correlation analysis between the mean CT value and T, N stage was conducted and the mean CT value of mesorectum of different T, N stages was compared. Results: The mean CT value of mesorectum and the T stage of rectal cancer were positively correlated (rs = 0.439, P < 0.001). The mean CT value of T4 was significantly higher than T1-3(all P < 0.05), but there was no statistical difference between each pair of T1, T2 and T3 (all P > 0.05). There was no statistical correlation between the mean CT value and N stage of rectal cancer (rs = 0.030, P = 0.740). The mean CT value of mesorectum had no statistically difference between each pair of N0, N1, N2 (all P > 0.05). Conclusion: The CT value of mesorectum can be a useful index to help identify whether the tumor has invaded out of the mesorectum or not in the middle and lower rectal cancer.


陈晓曦, 卢春燕, 欧阳书睿, 郭睿, 林峰洋, 张玉龙, 谭书文, 杨烈, 周总光. 直肠系膜CT值测量在中下段直肠癌术前分期中的临床价值[J]. 世界肿瘤研究, 2013, 3(4): 33-37. http://dx.doi.org/10.12677/wjcr.2013.34006


[1] American College of Radiology. Pretreatment staging of colo- rectal cancer. 2012. http://www.acr.org/
[2] S. Bipat, A. S. Glas, F. J. Slors, et al. Rectal cancer: Local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—A meta-analysis. Radiology, 2004, 232(3): 773-783.
[3] The American Joint Committee on Cancer. AJCC cancer staging manual. 7th Edition, Berlin: Springer. http://www.cancerstaging.org/
[4] R. J. Heald, R. D. H. Ryall. Recurrence and survival after total mesorectal excision forrectal cancer. The Lancet, 1986, 327(8496): 1479-1482.
[5] 顾晋. 全直肠系膜切除术[J]. 中华外科杂志, 2004, 42(15): 950-952.
[6] A. Filippone, R. Ambrosini, M. Fuschi, et al. Preoperative T and N staging of colorectal cancer: Accuracy of contrast-enhanced multi-detector row CT colonography—initialexperience1. Radi- ology, 2004, 231(1): 83-90.
[7] B. G. Czito, C. G. Willett. Rectal cancer: International pers- pectives on multimodality management. Berlin: Springer, 2010: 21-26.
[8] 王亚宁, 时高峰, 杜煜. 比较 MSCT与MRI在结直肠癌术前分期诊断中的价值[J]. 医学影像技术, 2011, 27(4): 772-775.
[9] 容蓉, 孙晓伟, 王霄英等. MRI 和 CT 对原发直肠癌术前N分期的诊断研究[J]. 实用放射学杂志, 2011, 27(10): 1495- 1498.
[10] 吴俊华, 欧阳书睿, 汪晓东等. 结直肠癌转移性淋巴结形态学标准的研究[J]. 实用放射学杂志, 2010, 26(5): 681-684.
[11] 郑阳春, 周总光, 王蓉等. 直肠癌系膜内淋巴结微转移及其临床意义分析[J]. 中国实用外科杂志, 2004, 24(9): 551-553.