【双语病例】直肠腺癌

病史

Female, 62 year(s)

女性,62岁。

The patient presented with a 4 month history of changed bowel habit and blood in the stool. Rectoscopy revealed a 4cm tumour in the lower rectum. Before treatment, high-resolution magnetic resonance imaging (MRI) of the pelvis was performed.

患者大便性状改变伴血便4个月。直肠镜可见直肠下段肿块,直径约4cm。

治疗前,患者行盆腔高分辨MRI检查。

影像学检查On T2-weighted images, a 4cm polypoid tumour in the lower rectum was found. The tumour did not seem to invade the propria muscle layer of the rectum, nor to infiltrate the perirectal fat. No malignant lymph nodes could be observed. The MR findings were consistent with a T0-T1N0 tumour according to the TNM-classification (UICC).
T2WI示直肠下段可见直径约4cm的息肉样肿块,肿块尚未累及固有层,直肠周围间隙也无明显受侵。盆腔内未见明显肿大淋巴结。MRI诊断为T0-T1 N0期直肠癌。

【双语病例】直肠腺癌

Sagittal T2-weighted turbo spin-echo image showing polypoid tumour in the rectal wall (arrow).

矢状位T2WI TSE图像示直肠壁息肉样肿块(箭头所示)。

【双语病例】直肠腺癌

Axial T2-weighted turbo spin-echo image showing polypoid tumour in the rectal wall (arrow). The surgical excision plane when removing rectal tumours with total mesorectal excision is marked with a dotted line.

横断位T2WI TSE序列可见直肠壁息肉样肿块。虚线标记为直肠肿块及直肠全系膜切除术的计划切除区域。

【双语病例】直肠腺癌

Rectal Adenocarcinoma直肠腺癌

讨论Colorectal cancer is the third leading cause of cancer death worldwide. At the time of diagnosis, the majority of tumours have already penetrated the rectal wall.

For many years, clinical examination by digital examination, rectoscopy and histological analysis of a biopsy specimen was considered to be sufficient for treatment planning.

结肠直肠癌是全球癌症死亡的第三大原因。通常在发现病变时,肿瘤已经穿透了直肠壁。既往认为,直肠指检、直肠镜、组织活检能够满足临床治疗的需要。

Now, new imaging techniques such as endorectal ultrasonography, computed tomography and magnetic resonance imaging allow presurgical assessment of tumour spread and metastatic pathways. These can greatly improve tumour staging in the individual patient. The particular benefit of ultrasonography is the possibility of visualising up to five layers of the rectal wall and thus determining the degree of tumour infiltration within the rectal wall. Tumours limited to the mucosa and submucosa (T0-T1) without lymph node metastases may be locally resected.

现在,新的影像学检查技术不断进步,直肠内超声、CT、MRI能够术前判断肿瘤的播散及远处转移情况,尤其是直肠内超声检查,能够清晰显示直肠壁的五层结构,从而准确判断肿瘤对直肠壁的受侵程度。局限于粘膜层和粘膜下层(T0-T1期)、但不伴有淋巴结转移的肿瘤,可以通过手术局部切除。

MRI is being used more and more in preoperative evaluation since the relationship between the tumour, the rectal wall and the mesorectal fascia can be visualised. The mesorectal fascia constitutes the surgical resection plane when performing a total mesorectal excision of the rectum. If this resection plane is involved by tumour, the risk of local tumour recurrence is high.

由于MRI可以清楚显示肿瘤、直肠壁、直肠系膜筋膜之间的关系,所以在直肠癌术前评估中应用越来越多。当患者准备行直肠全系膜切除术的时候,直肠系膜筋膜是手术切除的区域。如果肿瘤已经侵犯了该区域,术后复发的几率将会较高。

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