Houvenaeghel G, Delpero J R, Giovannini M, Orsoni P, Seitz J F, Rosello R, Resbeut M, Monges G, Guerinel G
Institut J. Paoli-I. Calmettes, Marseille, France.
Acta Chir Belg. 1993 Jul-Aug;93(4):164-8.
Between January 1988 and January 1992, 34 patients with rectal cancer were evaluated both by clinical examination and endosonography before and after pre-operative radiotherapy. Two criteria were correlated with histologic findings: confinement to the rectal wall or spread beyond, the presence of mesorectal lymph node involvement. The 32 patients who underwent endosonography before radiotherapy were staged as: uT2: 4, uT3: 26, uT4: 2 cases. Fifteen days after irradiation, endosonography showed tumour regression in all cases; uT stage was different in 15 patients, uN stage in 4 cases. Comparison of the pre-operative local invasion beyond the rectal wall with postoperative histopathy revealed a correlation with: digital examination after radiotherapy in 20 of the 31 patients with palpable tumours; endosonography before irradiation in 18 of the 32 staged tumours; endosonography after irradiation in 25 of the 32 staged tumours. The presence of mesorectal lymph node involvement determined by histologic examination was correlated with the results of endosonography after radiotherapy for 22 of the 32 staged tumours. Endosonography provides a good assessment of the tumour stage before irradiation. Since radiotherapy alters endosonographic staging of rectal cancer, this staging should be included in survival studies.
1988年1月至1992年1月期间，对34例直肠癌患者在术前放疗前后均进行了临床检查和内镜超声检查。两项标准与组织学结果相关：肿瘤局限于直肠壁或侵犯直肠壁外，以及存在直肠系膜淋巴结受累情况。32例在放疗前行内镜超声检查的患者分期如下：uT2期4例，uT3期26例，uT4期2例。放疗15天后，内镜超声检查显示所有病例肿瘤均有退缩；15例患者的uT分期不同，4例患者的uN分期不同。术前直肠壁外局部侵犯情况与术后组织病理学比较显示，与以下因素相关：31例可触及肿瘤患者中，20例在放疗后进行指诊；32例已分期肿瘤中，18例在放疗前行内镜超声检查；32例已分期肿瘤中，25例在放疗后行内镜超声检查。组织学检查确定的直肠系膜淋巴结受累情况与32例已分期肿瘤中22例放疗后的内镜超声检查结果相关。内镜超声检查能很好地评估放疗前的肿瘤分期。由于放疗会改变直肠癌的内镜超声分期，因此该分期应纳入生存研究。
