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目的:探讨64层螺旋CT增强扫描检查对结直肠癌术前T分期的临床应用价值。方法:对2012年3月~10月在我院行64层螺旋CT增强扫描,术后病理证实为结直肠癌的173例患者的CT成像结果进行回顾性分析。将CT分期的结果与术后病理分期结果进行一致性比较分析,并对肿瘤长度、CT值、病理分型等进行相关分析及比较。结果:CT术前T分期:T1-2期、T3期、T4期的灵敏度分别为60.90%(14/23)、89.92%(116/129)、95.24%(20/21),特异度为95.33%(143/150)、77.27%(34/44)、96.05%(146/152),准确率为66.67%(14/21)、92.01%(116/126)、76.92%(20/26),诊断一致性检验结果 Kappa=0.685,P=0.000,P<0.05,有统计意义。不同病理分期中肿瘤长度及不同病理分型中肿瘤CT值方差分析结果,P<0.05,有统计意义。不同病理分期中CT值方差分析结果,P>0.05,没有统计意义。病理分期与病理分型的X2检验结果,P<0.05,有统计意义。对T1-2过分期和T3低分期两组病例进一步分析,发现增强扫描后强化程度、管壁僵硬和浆膜不光整有助于鉴别T1-2过分期和T3期低分期,能够提高T1-2期和T3期的准确性。结论:64层螺旋CT增强扫描多种征象的相互结合有助于提高结直肠癌术前分期的准确性,对临床诊治有重要价值。
Objective: To investigate the clinical value of 64-slice spiral CT enhanced scan in preoperative T staging of colorectal cancer. Methods: CT images of 173 patients with colorectal cancer confirmed by histopathology from March to October in 2012 were retrospectively analyzed. The results of CT staging and postoperative pathological staging results were consistent analysis of consistency, and tumor length, CT value, pathological type, such as correlation analysis and comparison. Results: The T stage of preoperative CT was 60.90% (14/23), 89.92% (116/129) and 95.24% (20/21) respectively in T1-2, T3 and T4. The specificity was 95.33 The positive rates were 66.67% (14/21), 92.01% (116/126), 76.92% (20/26), respectively Diagnostic consistency test results Kappa = 0.685, P = 0.000, P <0.05, with statistical significance. The results of variance analysis of tumor CT values in different pathological stages of tumor length and different pathological types, P <0.05, have statistical significance. In different pathological staging CT value analysis of variance results, P> 0.05, no statistical significance. Pathological staging and pathological classification of the X2 test results, P <0.05, statistically significant. Further analysis of T1-2 over-stage and T3 low-stage two groups of patients and found that enhanced enhancement of the scan, the stiffness of the wall and the serosa not only help differentiate T1-2 overexpression and T3 low stage, can improve the T1- Phase 2 and T3 accuracy. Conclusion: The combination of multiple signs of 64-slice spiral CT enhanced scan can help improve the accuracy of preoperative staging of colorectal cancer and is of great value in clinical diagnosis and treatment.