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中华医学超声杂志(电子版) ›› 2018, Vol. 15 ›› Issue (12) : 953 -959. doi: 10.3877/cma.j.issn.1672-6448.2018.12.013

所属专题: 文献

腹部超声影像学

经直肠腔内灌注肠道超声造影诊断结直肠占位性病变的价值
张丽娟1, 陈科岐2, 郑孝志2,(), 吴菁2, 顾星2, 夏恩慧2, 李必瑾3, 宋署4   
  1. 1. 210031 南京医科大学第四附属医院超声科
    2. 224005 江苏省盐城市第一人民医院超声科
    3. 224005 江苏省盐城市第一人民医院消化内科
    4. 224005 江苏省盐城市第一人民医院病理科
  • 收稿日期:2017-02-16 出版日期:2018-12-01
  • 通信作者: 郑孝志

Reliability of intrarectal contrast-enhanced ultrasonography in detection of colorectal space-occupying lesions

Lijuan Zhang1, Keqi Chen2, Xiaozhi Zheng2,(), Jing Wu2, Xing Gu2, Enhui Xia2, Bijin Li3, Shu Song4   

  1. 1. Department of Ultrasound, The Fourth Affiliated Hospital with Nanjing Medical University, Nanjing 210031, China
    2. Department of Ultrasound, The First People's Hospital of Yancheng, Yancheng 224005, China
    3. Department of Gastroenterology, The First People's Hospital of Yancheng, Yancheng 224005, China
    4. Department of Pathology, The First People's Hospital of Yancheng, Yancheng 224005, China
  • Received:2017-02-16 Published:2018-12-01
  • Corresponding author: Xiaozhi Zheng
  • About author:
    Corresponding author: Zheng Xiaozhi, Email:
引用本文:

张丽娟, 陈科岐, 郑孝志, 吴菁, 顾星, 夏恩慧, 李必瑾, 宋署. 经直肠腔内灌注肠道超声造影诊断结直肠占位性病变的价值[J/OL]. 中华医学超声杂志(电子版), 2018, 15(12): 953-959.

Lijuan Zhang, Keqi Chen, Xiaozhi Zheng, Jing Wu, Xing Gu, Enhui Xia, Bijin Li, Shu Song. Reliability of intrarectal contrast-enhanced ultrasonography in detection of colorectal space-occupying lesions[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(12): 953-959.

目的

探讨经直肠腔内灌注肠道超声造影在结直肠占位性病变中的诊断价值。

方法

选取可疑结直肠占位性病变的患者196例,每例患者分别接受经直肠腔内灌注超声造影检查和肠道内窥镜检查。以外科手术病理结果作为"金标准",分析比较经直肠腔内灌注超声造影检查和肠道内窥镜检查诊断结直肠占位性病变的准确性。

结果

经直肠腔内灌注超声造影观察结肠和直肠的解剖结构和病变特征,发现恶性占位性病变81例,其中结肠癌39例,直肠癌42例;良性占位性病变30例,其中直肠息肉11例,结肠息肉19例。经直肠腔内灌注超声造影探查结直肠占位性病变的位置、数目和>10 mm的病变,其敏感度、特异度、阳性预测值、阴性预测值和准确性,与肠道内窥镜检查比较,均无显著差异。经直肠腔内灌注超声造影检查与肠道内窥镜检查在判断病变位置和数目方面均具有良好的一致性(K值=0.97,0.98)。两者在判断结直肠占位性病变大小方面的一致性因病变大小而不同:对于<5 mm、5~10 mm、>10 mm的结直肠占位性病变的探查,两种检查方法的一致性K值分别为0.82,0.89,0.98,其敏感度、特异度、阳性预测值、阴性预测值和准确性结果也显示在探查微小的(<5 mm)黏膜病变时,肠道内窥镜检查略优于经直肠腔内灌注超声造影检查。在探查经手术证实的周围组织浸润病变时,经直肠腔内灌注超声造影检查明显优于肠道内窥镜检查。

结论

经直肠腔内灌注超声造影检查可以有效探查结直肠占位性病变的位置和范围,与肠道内窥镜检查互补性强,其可作为结直肠占位性病变的常规检查方法之一。

Objective

To evaluate the reliability of intrarectal contrast-enhanced ultrasonography in the detection of colorectal space-occupying lesions.

Methods

One hundred and ninety-six consecutive patients with suspected colonic and rectal lesions (colorectal cancer or colorectal polyps), who had undergone intrarectal contrast-enhanced ultrasonography and endoscopic evaluation, were enrolled in the study. Each examination was performed independently by two operators. Using surgical pathological findings as the gold standard, the accuracy of intrarectal contrast-enhanced ultrasonography was determined and compared with intestinal endoscopy.

Results

After intrarectal contrast administration, the anatomy of the colon and rectum as well as the morphologic features of the lesions in these locations were clearly visualized. There were 81 cases of malignant lesions including colon cancer (n=39) and rectal cancer (n=42), and 30 cases of benign lesions including rectal polyps (n=11) and colonic polyps (n=19). The sensitivities, specificities, positive predictive values, negative predictive values and accuracies of intrarectal contrast-enhanced ultrasonography in detecting lesion site, size (>10 mm), number, and extents were similar to those of intestinal endoscopy. Moreover, intrarectal contrast-enhanced ultrasonography was far better than intestinal endoscopy in detecting adjacent structure abnormalities as identified at surgical pathology. However, intrarectal contrast-enhanced ultrasonography was a bit poorer than intestinal endoscopy in detecting minor mucosal abnormalities (<5 mm).

Conclusions

Intrarectal contrast-enhanced ultrasonography can effectively define the anatomic location and extension of colorectal space-occupying lesions, whose diagnostic performance is not worse than intestinal endoscopy. It can be used as a routine examination method for colorectal space-occupying lesions.

图1~6 经直肠腔内灌注超声造影检查肠道各段的标准切面图。图1为直肠末端及肛管长轴观(箭头所示为气囊);图2为直肠长轴观;图3为乙状结肠和降结肠长轴观;图4为横结肠长轴观;图5为升结肠和回盲部长轴观(三角形所示为升结肠,箭头所示为回盲瓣,五角形所示为回肠);图6为结肠和直肠短轴观
图10~12 横结肠腺癌的超声造影、肠道内窥镜和病理表现图像。图10为经直肠腔内灌注造影剂,造影剂充盈后超声探查显示横结肠腔呈高回声,肠管后壁可见形态不规则、边界不清晰的低回声区凸向肠腔,部分肠腔受阻,肠壁连续性不完整;图11为肠道内窥镜显示横结肠后壁可见形态不规则、表面不光滑伴有出血糜烂且基底较宽的肿瘤样病变凸向肠腔;图12为外科手术后病理检查结果提示横结肠腺癌(HE,×400)
表1 经直肠腔内灌注超声造影检查与肠道内窥镜检查对结直肠占位性病变位置的诊断结果(例)
表2 经直肠腔内灌注超声造影检查与肠道内窥镜检查对结直肠占位性病变位置的诊断价值(%)
表3 经直肠腔内灌注超声造影检查与肠道内窥镜检查对结直肠占位性病变数目的诊断结果(例)
表4 经直肠腔内灌注超声造影检查与肠道内窥镜检查对结直肠占位性病变数目的诊断价值(%)
表5 经直肠腔内灌注超声造影检查与肠道内窥镜检查对结直肠占位性病变大小的诊断结果(例)
表6 经直肠腔内灌注超声造影检查与肠道内窥镜检查对结直肠占位性病变大小的诊断价值(%)
表7 经直肠腔内灌注超声造影检查与肠道内窥镜检查对结直肠占位性病变周围组织浸润的诊断结果(例)
表8 经直肠腔内灌注超声造影检查与肠道内窥镜检查对结直肠占位性病变周围组织浸润的诊断价值(%)
表9 不同操作医师判断结直肠占位性病变的一致性分析[K值(95%可信区间)]
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