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目的 :探讨内镜超声 (endoscopicultrasonography ,EUS)在结直肠癌术前TNM分期中的应用价值。 方法 :对 81例手术切除的结直肠癌患者术前行内镜超声检查 ,所有病例术后均得到病理证实。结果 :EUS检查发现正常结直肠壁表现为5层结构 ,第 1 ,3,5层表现为高回声 ,第 2 ,4层表现为低回声。第 1 ,2层为黏膜层 ,第 3层为黏膜下层 ,第 4层为固有肌层 ,第 5层为浆膜下和浆膜层。EUS下结直肠癌表现为低回声肿块 ,其回声强度介于第 3层高回声和第 4层低回声之间。根据EUS下结直肠壁 5层结构和邻近器官的改变判断肿瘤侵犯的深度 ,进行T分期诊断。肿瘤旁直径≥ 5mm圆形的低回声病灶诊断为转移性淋巴结。EUS对结直肠癌T分期诊断总的准确率为 82 7% ,周围淋巴结转移诊断的敏感性和特异性为5 5 4 %和 6 8 7%。结论 :EUS对结直肠癌侵犯深度的判断有较高的准确率 ,对术前TNM分期诊断有一定价值。术前EUS检查可以为结直肠癌选择合适的治疗方案提供指导
Objective: To investigate the value of endoscopic ultrasonography (EUS) in preoperative TNM staging of colorectal cancer. Methods: 81 cases of resected colorectal cancer patients underwent endoscopic ultrasonography before surgery, all cases were pathologically confirmed. Results: EUS examination showed that the normal colorectal wall showed a 5-layer structure. The first, third and fifth layers showed hyperechoic and the second and fourth layers showed hypoechoic. The first and second layers are the mucosal layer, the third layer is the submucosa, the fourth layer is the muscularis propria, and the fifth layer is the subserosal and serosal layer. EUS colorectal cancer showed hypoechoic mass, the echo intensity between the third layer of hyperechoic and the fourth floor hypoechoic. According to EUS under the 5-layer structure of the colorectal wall and changes in adjacent organs to determine the depth of tumor invasion, T stage diagnosis. A tumor with a diameter of ≥ 5mm circular hypoechoic lesions was diagnosed as metastatic lymph nodes. The overall diagnostic accuracy of EUS for T staging of colorectal cancer was 82.7%, and the sensitivity and specificity for diagnosis of peripheral lymph node metastases were 54.4% and 68.7%. Conclusion: The accuracy of EUS in judging the invasion depth of colorectal cancer is high, and it is of value to the preoperative TNM staging diagnosis. Preoperative EUS examination can provide guidance for the selection of appropriate treatment for colorectal cancer