充水大腸經腹部超音波術於評估大腸直腸腫瘤的應用--癌侵犯深度評估之補充性工具

超音波在腸胃道疾患的診斷所扮演的角色越來越吃重. 而充水大腸經 腹部超音波術結合高解析度腹部超音波及經由肛門灌滿溫水之大腸, 被建 議用來取代大腸鏡以偵測大腸直腸息肉及癌症. 本篇研究的目的在研究 是否大腸直腸腫瘤的偵測率及腫瘤侵犯深度的預測率能被充水大腸經腹部 超音波所改善. 在本研究的六個月期間, 總計有連續二十五例進入本前 瞻性研究( 男性十二例, 女性十三例, 年齡二十八至八十歲), 所有病例 在做充水大腸經腹部超音波檢查前均已做過下消化道攝影的評估. 其中二 十二例為大腸直腸癌, 三例為非睿生性病變( 闌尾膿瘍一例, 肉芽腫性大 腸炎一例, 腺瘤一例), 傳統腹部超音波僅有28% 的陽性率,偵測大腸直腸 癌的敏感度為31.8% ,可說是相當低; 而充水大腸經腹部超音波的陽性率 可達到96% ,偵測大腸直腸癌的敏感度為95.5%. 在超音波學的診斷上, 它 的確展現了相當大程度的改進. 同時它亦能用來檢視腸壁的構造, 所獲得 的影像相當於內視超音波, 在決定腫瘤侵犯深度也有高度的準確性, 在本 研究中, 只有二例判讀失誤. 因此我們認為充水大腸經腹部超音波術在 術前診斷及術前腫瘤侵犯深度的決定上有著高度的敏感度, 特異度及預測 值. 病人均能忍受此項檢查且時間短, 故可用於檢查門診病人.

Ultrasonic examination has become increasing important in the diagnosis of disease of the gastrointestinal tract. Hydrocolonic sonography--abdominal ultrasonography in conjunction with the retrograde instillation of pre-warmed saline into the colon--has been advocated as an alternative tocolonoscopy for detecting colorectal polyps and cancer. The aim of this study was to determine whether the detection and tumor invasion depth staging would be improved by the hydrocolonic sonography. Over the course of 6 months, a total of 25 consecutive patients, (12M, 13F,age 28-80 years-old) were enrolled in this prospective study. All cases wereevaluated with double-contrast barium enema prior to this hydrocolonicsonography. There were 22 cases of colorectal carcinomas and 3 cases of non-neoplasticlesions( appendiceal abscess 1, granulomatous colitis 1, adenoma 1).Conventional trans-abdominal sonography had only 28% positive rate, withsensitivity 31.8%.While hydrocolonic sonography had 96% positive rate,with sensitivity 95.5%. It demonstrated that marked improvement in the ultrasonic diagnosis of colonic tumor can be achieved with hydrocolonic sonography. Also hydrocolonic sonography can examine structure of the bowel wall with a clarity comparable to that achieved with endosonography andto determine the tumor invasion depth with a high degree of accuracy. In ourstudy, only 2 cases were missed-reading. In conclusion, Hydrocolonic sonography allows the diagnosis and pre-operativeT-staging of colorectal carcinomas with high sensitivity, specificity, and predictive value. It is well tolerated by patients and is thus particularlywell suited for the diagnosis of colonic tumors in outpatients.