Sentovich S M, Blatchford G J, Falk P M, Thorson A G, Christensen M A
Department of Surgery, University School of Medicine, Omaha, Nebraska 68131.
Am J Surg. 1993 Dec;166(6):638-41; discussion 641-2. doi: 10.1016/s0002-9610(05)80670-1.
Since preoperative staging of rectal tumors is important in planning treatment, we evaluated transrectal ultrasound (TRUS) staging of rectal neoplasms. In 35 consecutive rectal tumors, we compared TRUS staging results with final pathologic staging. TRUS predicted the degree of tumor invasion in 19 of 24 patients (79%) and the presence or absence of lymph node metastasis in 11 of 15 patients (73%). TRUS overestimated the degree of tumor invasion in four patients (17%) and underestimated invasion in one patient (4%). The depth of tumor invasion was correctly predicted in all 14 tumors located within 6 cm from the anal verge, but, beyond 6 cm, only 5 of 10 tumors (50%) were staged correctly (p = 0.005). In the group of 11 patients who underwent preoperative radiotherapy, pretreatment TRUS predicted the depth of tumor invasion in only six patients (55%) and overestimated tumor invasion in five patients (45%), suggesting that nearly half of these tumors were downstaged by radiotherapy. TRUS accurately predicts the degree of tumor invasion, especially in tumors closer to the anal verge, allowing for better treatment planning in patients with low to middle rectal neoplasms.
由于直肠肿瘤的术前分期对于治疗方案的规划至关重要，我们对直肠肿瘤的经直肠超声（TRUS）分期进行了评估。在连续的35例直肠肿瘤患者中，我们将TRUS分期结果与最终病理分期进行了比较。TRUS在24例患者中的19例（79%）中预测了肿瘤浸润程度，在15例患者中的11例（73%）中预测了有无淋巴结转移。TRUS在4例患者（17%）中高估了肿瘤浸润程度，在1例患者（4%）中低估了浸润程度。在距肛缘6 cm以内的所有14例肿瘤中，肿瘤浸润深度均被正确预测，但在6 cm以外，10例肿瘤中只有5例（50%）分期正确（p = 0.005）。在11例接受术前放疗的患者组中，放疗前TRUS仅在6例患者（55%）中预测了肿瘤浸润深度，在5例患者（45%）中高估了肿瘤浸润程度，这表明这些肿瘤中近一半通过放疗实现了降期。TRUS能够准确预测肿瘤浸润程度，尤其是在距肛缘较近的肿瘤中，有助于为中低位直肠肿瘤患者制定更好的治疗方案。
