| Objective:To explore the CT clinical application value in rectal cancer staging; To analysis of rectal cancer mesorectum fascia infencted imaging demonstrated on CT images, to explore its correlation with postoperative local recurrence.Materials and methods:To collect the second people’s hospital of neijiang during January 2011 to December 2012, lower rectal carcinoma operation and follow-up of 80 cases of patients, 52 cases of men, 28 cases of women, all cases were performed total mesorectum excision and surgical pathology confirmed, and at the same time for the longest 2 years of follow-up.All the 64 cases by GE 128 layer spiral CT line full abdominal plain scan and enhanced scan, multi-azimuth after reorganization, the preoperative CT staging of rectal cancer, and compared with pathological staging contrast analysis; Again respectively for the patient gender, age, degree of mesorectum fascia infiltration, circumferential cut edge state judgment analysis and lymph node metastasis, explore its correlation with postoperative local recurrence; Reanalysis mesorectum fascia affected depth, and presence of regional lymph node metastasis and recurrence time relationship.Observe the content includes the following:(1) to observe the tumor invasion degree of intestinal wall.(2) the tumor and the mesorectum fascia around the relationship. Judge mesorectum fascia invaded standard: tumors from outer mesorectum fascia fat clearance is less than 2 mm(measurement methods: mesorectum fascia spacing tumors, tumor nodules, local metastasis lymph node distance mesorectum fascia closest); Tumors had the outer burrs or diffuse soft tissue density invasion mesorectum fascia.(3) to observe the mesorectum fascia the degree of involvement, the shortest distance to tumor and rectum fascia, intestinal wall muscle layer of the outside of the rim and tumor distance for D1, the mesenteric thickness corresponding to DO. Expressed in D1 / DO to the extent of the mesorectum involvement, the degree of involvement will be divided into three degrees: I degree is less than or equal to 1/3, two-thirds less than, greater than 1/3 Ⅱ degree, Ⅲ degrees more than two-thirds, including T1 or T2 stage was classified into degrees, I because without tumor invasion and the mesorectum; T4 is divided into the first Ⅲ degrees, penetrates the mesorectum for tumors.(4) the circumferential cutting edge(circumferential resection margin, CRM) positive judgment: according to the Beets- Tan research standard, with most rim or mesangial lymph nodes and tumor edge distance with CRM, the shortest distance measured on CT < 5 mm with CRM < 1 mm highly correlated, notes for CRM(+), whereas for CRM(-).(5) To observe straight in the mesenteric lymph nodes;(6)for postoperative follow-up, recurrence of records the time and place.Results:1, 80 cases of lower rectal cancer in CT staging: T1 phase 8 cases, T2 phase in 24 cases, T3 phase in 36 cases, and T4 phase in 12 cases; Its pathological staging: T1 phase in 7 cases, T2 phase in 26 cases, T3 phase in 36 cases, T4 phase in 11 cases. Lymph node positive 29 cases CT judgment, lymph node negative 51 cases; Pathological lymph node positive 28 cases, lymph node negative 52 cases.CT on the sensitivity of the T1, T2, T3, T4 staging were 85.7%, 76.9%, 86.1% and 90.9% respectively; Specific degree 97.5%, 94.4%, 90.1% and 97.1% respectively; Positive predictive were 75.0%, 83.3%, 86.1%, 83.3%, negative predictive value of 98.5%, 89.2%, 98.5% and 89.2% respectively.To determine the sensitivity of the lymph nodes(+) and positive predictive value were 89.2%, 86.2%; On the judgement of the specific degree of lymph nodes(-) are 92.3% and 92.3% respectively; Through the consistency check(chi-square test) that preoperative CT staging and pathologic analysis with high consistency(r=0.885 and 0.909,P=0,P<0.05).2, 80 cases of postoperative recurrence of 2 years in 48 cases, the recurrence rate 60%; Found that postoperative recurrence, the shortest time about 2 months, the longest 24 months follow-up time, were the average recurrence time(9.7 ± 6.3) months. Postoperative recurrence parts: 16 cases of anastomotic, pelvic floor sacral clearance before 22 cases, 9 cases of anus, lymph nodes in 1 case.3, with age is divided into four groups; Every 10 years old between 40 to 80 years for an age group. Through statistical analysis of patients with gender, age and whether postoperative recurrence, no correlation(r=0.418 and 0.7,P value is 0.725 and 0.188,P>0.05).4, mesorectum infiltration depth and there is a clear correlation between postoperative local recurrence(r=0.868,P value is 0,P<0.05); CRM recurrence was higher than that of the CRM negatie, the difference was statistically significant(r = 0.918, P is 0, P < 0. 05), that is associated with postoperative local recurrence; Preoperative have mesorectum fascia in lymph node metastasis of postoperative local recurrence rate higher than without lymph node metastasis, the difference was statistically significant(r = 0.779, P value is 0, P < 0. 05), that is associated with postoperative local recurrence.5, mesorectum infiltration depth and mesorectum intra-fascial clearly related to the regional lymph node metastasis and recurrence time(chi-square values of 72 and 138 respectively, P = 0, P < 0.05), the difference was statistically significant. Concolusion:Part 1, CT can accurately show colorectal cancer, the size, scope of involvement and the surrounding fascia; CT on the sensitivity of the T/N staging, specific degree, positive predictive value, negative predictive value is higher, especially for T3, T4 and judgment of lymph node metastasis on the measurements are above 86%, and the better consistency with the pathological staging. Therefore, CT can be used as a routine preoperative staging evaluation method, to determine the rectum surrounding fascia infiltration and infiltration depth of higher application value.2, recurrence of rectal cancer patients with gender, age, there is no clear correlation with rectal tumor outer invasion depth, the degree of involvement of mesorectum fascia, circumferential cutting edge condition and is closely related to the presence of metastasis lymph nodes in the mesorectum. 3, mesorectum infiltration depth, the greater the mesorectum intra-fascial area has the higher the lymph node metastasis, postoperative recurrence rate in the short term. |
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