• 1.四川大學(xué)華西臨床醫(yī)學(xué)院/華西醫(yī)院(成都610041);;
  • 2.四川大學(xué)華西醫(yī)院肛腸外科（成都610041）;

目的 　總結(jié)直腸癌術(shù)前分期策略的研究進(jìn)展。
方法 　對(duì)有關(guān)直腸癌術(shù)前分期方法的文獻(xiàn)進(jìn)行綜述，對(duì)新近提出的多模式術(shù)前評(píng)估（multimodal preoperative evaluation，MPE）系統(tǒng)的相關(guān)資料進(jìn)行重點(diǎn)總結(jié)。
結(jié)果 　恰當(dāng)選擇目前存在的方法在直腸癌T分期及M分期上可以取得較高的準(zhǔn)確性，但都不能對(duì)淋巴結(jié)轉(zhuǎn)移進(jìn)行準(zhǔn)確評(píng)估。在多學(xué)科協(xié)作診治模式下，采用MPE系統(tǒng)，即聯(lián)合經(jīng)直腸超聲、計(jì)算機(jī)斷層掃描技術(shù)和血清淀粉樣蛋白A評(píng)估直腸癌，可取得目前較為準(zhǔn)確的術(shù)前分期。
結(jié)論 　MPE系統(tǒng)評(píng)估直腸癌術(shù)前分期具有良好的臨床應(yīng)用前景。

引用本文： 楊靚,汪曉東,秦昌龍,李立. 直腸癌術(shù)前分期策略. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(9): 714-717. doi: 復(fù)制

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國(guó)普外基礎(chǔ)與臨床雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

1. 汪曉東, 宋歡, 盧聰, 等. 骨盆測(cè)量在直腸癌手術(shù)中的應(yīng)用進(jìn)展 [Ｊ]. 醫(yī)學(xué)與哲學(xué), 2009; 30(4): 45-46.
2. Thoeni RF. Colorectal cancer: cross-sectional imaging for staging of primary tumor and detection of local recurrence [Ｊ]. AJR Am J Roentgenol, 1991; 156(5): 909-915.
3. Rotte KH, Klühs L, Kleinau H, et al. Computed tomography and endosonography in the preoperative staging of rectal carcinoma [Ｊ]. Eur J Radiol, 1989; 9(3): 187-190.
4. Kim NK, Kim MJ, Yun SH, et al. Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer [Ｊ]. Dis Colon Rectum, 1999; 42(6): 770-775.
5. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85-118.
6. Hodgman CG, MacCarty RL, Wolff BG, et al. Preoperative staging of rectal carcinoma by computed tomography and 0.15 T magnetic resonance imaging. Preliminary report [Ｊ]. Dis Colon Rectum, 1986; 29(7): 446-450.
7. Maldjian C, Smith R, Kilger A, et al. Endorectal surface coil MR imaging as a staging technique for rectal carcinoma: a comparison study to rectal endosonography[Ｊ]. Abdom Imaging, 2000; 25(1): 75-80.
8. Beets-Tan RG, Beets GL. Rectal cancer: review with emphasis on MR imaging [Ｊ]. Radiology, 2004; 232(2): 335-346.
9. Halefoglu AM, Yildirim S, Avlanmis O, et al. Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer [Ｊ]. World J Gastroenterol, 2008; 14(22): 3504-3510.
10. Wiggers T, van de Velde CJ. The circumferential margin in rectal cancer. Recommendations based on the Dutch Total Mesorectal Excision Study[Ｊ]. Eur J Cancer, 2002; 38(7): 973-976.
11. Mnig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [Ｊ]. Ann Surg Oncol, 1999; 6(6): 579-581.
12. Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer [Ｊ]. Int J Colorectal Dis, 2000; 15(1): 9-20.
13. Lahaye MJ, Engelen SM, Kessels AG, et al. USPIO-enha-nced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria [Ｊ]. Radiology, 2008; 246(3): 804-811.
14. Wolberink SV, Beets-Tan RG, Nagtegaal ID, et al. Preoperative assessment of the circumferential margin in rectal cancer is more informative in treatment planning than the T stage [Ｊ]. Tech Coloproctol, 2006; 10(3): 171-176.
15. Wieder HA, Rosenberg R, Lordick F, et al. Rectal cancer: MR imaging before neoadjuvant chemotherapy and radiation therapy for prediction of tumor-free circumferential resection margins and long-term survival [Ｊ]. Radiology, 2007; 243(3): 744-751.
16. Brown G, Daniels IR. Preoperative staging of rectal cancer: the MERCURY research project [Ｊ]. Recent Results Cancer Res, 2005; 165: 58-74.
17. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound [Ｊ]. Dis Colon Rectum, 1985; 28(1): 42-46.
18. Badea R, Badea G, Philippi W, et al. The value and limits of endorectal sonography in the preoperative stage classification of rectal cancer [Ｊ]. Ultraschall Med, 1988; 9(6): 265-269.
19. Siddiqui AA, Fayiga Y, Huerta S. The role of endoscopic ultrasound in the evaluation of rectal cancer [Ｊ]. Int Semin Surg Oncol, 2006; 3: 36.
20. Kim JC, Kim HC, Yu CS, et al. Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging [Ｊ]. Am J Surg, 2006; 192(1): 89-97.
21. Wiersema MJ, Harewood GC. Endoscopic ultrasound for rectal cancer [Ｊ]. Gastroenterol Clin North Am, 2002; 31(4): 1093-1105.
22. Faneyte IF, Dresen RC, Edelbroek MA, et al. Pre-operative staging with positron emission tomography in patients with pelvic recurrence of rectal cancer [Ｊ]. Dig Surg, 2008; 25(3): 202-207.
23. 汪曉東, 呂東昊, 崔貝貝, 等. 術(shù)前經(jīng)直腸超聲評(píng)估直腸癌手術(shù)方案的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)循證醫(yī)學(xué)雜志, 2008; 8(12): 1043-1046.
24. 吳俊華, 汪曉東, 高強(qiáng), 等. 64排多層螺旋CT和血清淀粉樣蛋白A聯(lián)合評(píng)估下段直腸癌對(duì)手術(shù)方案選擇的影響 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(2): 156-161.
25. 汪曉東, 尹源, 陸玫竹, 等. 經(jīng)直腸超聲聯(lián)合血清淀粉樣蛋白A術(shù)前評(píng)估中低位直腸癌與手術(shù)決策的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(5): 407-412.
26. 汪曉東, 張瓊文, 呂東昊, 等. 64排多層螺旋CT和血清淀粉樣蛋白A聯(lián)合評(píng)估結(jié)腸癌對(duì)手術(shù)方案選擇的影響 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(3): 232-237.
27. 汪曉東, 呂東昊, 宋歡, 等. 多模式術(shù)前評(píng)估系統(tǒng)對(duì)中低位直腸癌手術(shù)方案選擇的價(jià)值： 一項(xiàng)隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(6): 487-492.
28. 汪曉東, 鄧?yán)? 呂東昊, 等. 結(jié)直腸癌患者術(shù)前SAA、CRP、CEA和CA19-9水平的臨床診斷價(jià)值 [Ｊ]. 四川醫(yī)學(xué), 2009; 30(3): 340-342.
29. d’Eril GM, Anesi A, Maggiore M, et al. Biological variation of serum amyloid A in healthy subjects [Ｊ]. Clin Chem, 2001; 47(8): 1498-1499.
30. 汪曉東, 宋歡, 呂東昊, 等. 術(shù)前聯(lián)合評(píng)估直腸上段癌與手術(shù)方案選擇的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(4): 322-326.
  1. 1. 汪曉東, 宋歡, 盧聰, 等. 骨盆測(cè)量在直腸癌手術(shù)中的應(yīng)用進(jìn)展 [Ｊ]. 醫(yī)學(xué)與哲學(xué), 2009; 30(4): 45-46.
  2. 2. Thoeni RF. Colorectal cancer: cross-sectional imaging for staging of primary tumor and detection of local recurrence [Ｊ]. AJR Am J Roentgenol, 1991; 156(5): 909-915.
  3. 3. Rotte KH, Klühs L, Kleinau H, et al. Computed tomography and endosonography in the preoperative staging of rectal carcinoma [Ｊ]. Eur J Radiol, 1989; 9(3): 187-190.
  4. 4. Kim NK, Kim MJ, Yun SH, et al. Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer [Ｊ]. Dis Colon Rectum, 1999; 42(6): 770-775.
  5. 5. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85-118.
  6. 6. Hodgman CG, MacCarty RL, Wolff BG, et al. Preoperative staging of rectal carcinoma by computed tomography and 0.15 T magnetic resonance imaging. Preliminary report [Ｊ]. Dis Colon Rectum, 1986; 29(7): 446-450.
  7. 7. Maldjian C, Smith R, Kilger A, et al. Endorectal surface coil MR imaging as a staging technique for rectal carcinoma: a comparison study to rectal endosonography[Ｊ]. Abdom Imaging, 2000; 25(1): 75-80.
  8. 8. Beets-Tan RG, Beets GL. Rectal cancer: review with emphasis on MR imaging [Ｊ]. Radiology, 2004; 232(2): 335-346.
  9. 9. Halefoglu AM, Yildirim S, Avlanmis O, et al. Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer [Ｊ]. World J Gastroenterol, 2008; 14(22): 3504-3510.
  10. 10. Wiggers T, van de Velde CJ. The circumferential margin in rectal cancer. Recommendations based on the Dutch Total Mesorectal Excision Study[Ｊ]. Eur J Cancer, 2002; 38(7): 973-976.
  11. 11. Mnig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [Ｊ]. Ann Surg Oncol, 1999; 6(6): 579-581.
  12. 12. Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer [Ｊ]. Int J Colorectal Dis, 2000; 15(1): 9-20.
  13. 13. Lahaye MJ, Engelen SM, Kessels AG, et al. USPIO-enha-nced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria [Ｊ]. Radiology, 2008; 246(3): 804-811.
  14. 14. Wolberink SV, Beets-Tan RG, Nagtegaal ID, et al. Preoperative assessment of the circumferential margin in rectal cancer is more informative in treatment planning than the T stage [Ｊ]. Tech Coloproctol, 2006; 10(3): 171-176.
  15. 15. Wieder HA, Rosenberg R, Lordick F, et al. Rectal cancer: MR imaging before neoadjuvant chemotherapy and radiation therapy for prediction of tumor-free circumferential resection margins and long-term survival [Ｊ]. Radiology, 2007; 243(3): 744-751.
  16. 16. Brown G, Daniels IR. Preoperative staging of rectal cancer: the MERCURY research project [Ｊ]. Recent Results Cancer Res, 2005; 165: 58-74.
  17. 17. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound [Ｊ]. Dis Colon Rectum, 1985; 28(1): 42-46.
  18. 18. Badea R, Badea G, Philippi W, et al. The value and limits of endorectal sonography in the preoperative stage classification of rectal cancer [Ｊ]. Ultraschall Med, 1988; 9(6): 265-269.
  19. 19. Siddiqui AA, Fayiga Y, Huerta S. The role of endoscopic ultrasound in the evaluation of rectal cancer [Ｊ]. Int Semin Surg Oncol, 2006; 3: 36.
  20. 20. Kim JC, Kim HC, Yu CS, et al. Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging [Ｊ]. Am J Surg, 2006; 192(1): 89-97.
  21. 21. Wiersema MJ, Harewood GC. Endoscopic ultrasound for rectal cancer [Ｊ]. Gastroenterol Clin North Am, 2002; 31(4): 1093-1105.
  22. 22. Faneyte IF, Dresen RC, Edelbroek MA, et al. Pre-operative staging with positron emission tomography in patients with pelvic recurrence of rectal cancer [Ｊ]. Dig Surg, 2008; 25(3): 202-207.
  23. 23. 汪曉東, 呂東昊, 崔貝貝, 等. 術(shù)前經(jīng)直腸超聲評(píng)估直腸癌手術(shù)方案的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)循證醫(yī)學(xué)雜志, 2008; 8(12): 1043-1046.
  24. 24. 吳俊華, 汪曉東, 高強(qiáng), 等. 64排多層螺旋CT和血清淀粉樣蛋白A聯(lián)合評(píng)估下段直腸癌對(duì)手術(shù)方案選擇的影響 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(2): 156-161.
  25. 25. 汪曉東, 尹源, 陸玫竹, 等. 經(jīng)直腸超聲聯(lián)合血清淀粉樣蛋白A術(shù)前評(píng)估中低位直腸癌與手術(shù)決策的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(5): 407-412.
  26. 26. 汪曉東, 張瓊文, 呂東昊, 等. 64排多層螺旋CT和血清淀粉樣蛋白A聯(lián)合評(píng)估結(jié)腸癌對(duì)手術(shù)方案選擇的影響 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(3): 232-237.
  27. 27. 汪曉東, 呂東昊, 宋歡, 等. 多模式術(shù)前評(píng)估系統(tǒng)對(duì)中低位直腸癌手術(shù)方案選擇的價(jià)值： 一項(xiàng)隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(6): 487-492.
  28. 28. 汪曉東, 鄧?yán)? 呂東昊, 等. 結(jié)直腸癌患者術(shù)前SAA、CRP、CEA和CA19-9水平的臨床診斷價(jià)值 [Ｊ]. 四川醫(yī)學(xué), 2009; 30(3): 340-342.
  29. 29. d’Eril GM, Anesi A, Maggiore M, et al. Biological variation of serum amyloid A in healthy subjects [Ｊ]. Clin Chem, 2001; 47(8): 1498-1499.
  30. 30. 汪曉東, 宋歡, 呂東昊, 等. 術(shù)前聯(lián)合評(píng)估直腸上段癌與手術(shù)方案選擇的隨機(jī)對(duì)照試驗(yàn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(4): 322-326.