Senesse P, Khemissa F, Lemanski C, Masson B, Quenet F, Saint-Aubert B, Simony J, Ychou M, Dubois J B, Rouanet P
CRLC Val-d'Aurelle, Montpellier.
Gastroenterol Clin Biol. 2001 Jan;25(1):24-8.
Abdominoperineal resection is the standard treatment of very low rectal carcinoma. Pretherapeutic evaluation of locoregional extension relies mainly on digital rectal examination. The interest of endorectal ultrasonography to assess lateral and inferior margins is still to be determined.
To assess the ability of endorectal ultrasonography to evaluate the possibility of conservative anal sphincter surgery.
Between April 1996 and June 1998, 34 patients (20 men, 14 women, mean age: 61 years, range: 43-80) have been treated for rectal adenocarcinoma. Endorectal ultrasonography was made with a linear probe (EUP-U33). Before treatment, the mean distance between the lower pole of the tumor and the anal verge was 3.9 cm (range: 2-5), and between the lower pole and the puborectalis sling 2.3 mm (range: 0-7). A uTN classification was made. Preoperative treatment was radiotherapy (40 Gy in 4 patients, 60 Gy in 24 patients), or radiochemotherapy (6 patients). Pre- and post-radiotherapy endorectal ultrasonography results were compared to the patholocical analysis of operative specimen.
Wall infiltration was correctly evaluated in 57% of patients after radiotherapy. In 26/34 cases, a safe plane existed before and after radiotherapy, and correlation of endorectal ultrasonography with histology was 96%. For patients without safe plane, correlation with histology was 75%.
For very low rectal tumors, with an aggressive sphincter conservation approach, endorectal ultrasonography allows to assess sphincter invasion with 96% fiability when safe plane exists.
腹会阴联合切除术是极低位直肠癌的标准治疗方法。局部区域扩展的治疗前评估主要依靠直肠指检。直肠内超声评估侧方和下方切缘的价值仍有待确定。
评估直肠内超声评估保留肛门括约肌手术可能性的能力。
1996年4月至1998年6月期间，34例患者（20例男性，14例女性，平均年龄：61岁，范围：43 - 80岁）接受了直肠腺癌治疗。使用线性探头（EUP - U33）进行直肠内超声检查。治疗前，肿瘤下极与肛缘的平均距离为3.9厘米（范围：2 - 5厘米），与耻骨直肠肌吊带的平均距离为2.3毫米（范围：0 - 7毫米）。进行了uTN分类。术前治疗为放疗（4例患者40 Gy，24例患者60 Gy）或放化疗（6例患者）。将放疗前后的直肠内超声检查结果与手术标本的病理分析进行比较。
放疗后57%的患者壁浸润得到正确评估。在26/34例病例中，放疗前后存在安全平面，直肠内超声与组织学的相关性为96%。对于没有安全平面的患者，与组织学的相关性为75%。
对于极低位直肠肿瘤，采用积极的保留括约肌方法，当存在安全平面时，直肠内超声能够以96%的可靠性评估括约肌浸润情况。
