經直腸超聲聯合血清淀粉樣蛋白A術前評估中低位直腸癌與手術決策的隨機對照試驗_《中國普外基礎與臨床雜志》

作者：

汪曉東 ¹ , 尹源 ² , 陸玫竹 ² , 呂東昊 ² , 白莉萍 ² , 時瑩瑜 ³ , 李臻輝 ⁴ , 李立 ¹

1.四川大學華西醫院肛腸外科（成都　610041）;;
2.四川大學華西臨床醫學院（成都 610041）;;
3.四川大學華西醫院超聲科（成都 610041）;;
4.四川大學華西醫院實驗醫學科(成都 610041);

關鍵詞：

直腸癌　經直腸超聲　血清淀粉樣蛋白A 　術前評估外科手術

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目的探討經直腸超聲檢查（TRUS）聯合血清淀粉樣蛋白A（SAA）術前評估中低位直腸癌的臨床價值和對手術決策的意義。方法前瞻性納入2008年6月至2009年2月期間于四川大學華西醫院肛腸外科住院的中低位直腸癌患者130例，隨機均分為TRUS聯合SAA組和TRUS組。TRUS聯合SAA組術前行TRUS和SAA聯合評估，TRUS組術前只行TRUS評估。將術前直腸癌分期和預測手術方案分別與術后病理分期和實際手術方案比較。結果本研究實際納入病例118例，TRUS聯合SAA組與TRUS組各59例，2組基線情況基本一致。TRUS聯合SAA組術前T、N分期的準確度分別為79.7%（47/59）和77.8%（42/54）， TRUS組術前T、N分期的準確度分別為86.4%（51/59）和57.7%（30/52）； 2組間T分期的準確度比較差異無統計學意義（P=0.609），N分期的準確度比較差異有統計學意義（P=0.027）。2組手術方案的預測符合率分別為96.6%（57/59）和83.1%（49/59），差異亦有統計學意義（P=0.015）。分析直腸癌手術方案的選擇與多種臨床病理因素的關系發現，術前T分期在不同手術方案之間的差異有統計學意義（P=0.037）。結論 TRUS聯合SAA術前評估中低位直腸癌患者的策略可以提高術前分期的準確性，并因此提高了中低位直腸癌手術方案預測的符合率。

引用本文： 汪曉東,尹源,陸玫竹,呂東昊,白莉萍,時瑩瑜,李臻輝,李立. 經直腸超聲聯合血清淀粉樣蛋白A術前評估中低位直腸癌與手術決策的隨機對照試驗. 中國普外基礎與臨床雜志, 2009, 16(5): 407-412. doi: 復制

1.	ASGE Standards of Practice Committee, Gan SI, Rajan E, et al. Role of EUS [Ｊ]. Gastrointest Endosc， 2007;　66(3): 425-334.
2.	Bipat S, Glas AS, Slors FJ,　 et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis　 [Ｊ].　 Radiology，　 2004;　232(3): 773-783.
3.	Glojnaric＇ I, Casl MT, Simic＇ D, et al. Serum amyloid A protein (SAA) in colorectal carcinoma [Ｊ]. Clin Chem Lab Med, 2001; 39(2): 129-133.
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5.	Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual　[Ｍ]. 6th ed. New York (NY): Springer-Verlag, 2002: 113-124.
6.	李立. 結直腸癌外科應用技術的規范與創新(一) [Ｊ]. 中國普外基礎與臨床雜志, 2006; 13(1): 106-109.
7.	李立. 結直腸癌外科應用技術的規范與創新(二) [Ｊ]. 中國普外基礎與臨床雜志, 2006; 13(2): 222-226.
8.	蔡三軍. 直腸癌的外科治療進展 [Ｊ]. 中國癌癥雜志, 2004; 14(5): 410-414.
9.	汪曉東，呂東昊，曾天芳, 等. 多學科協作診治模式下結直腸癌術前輔助檢查系統的臨床應用初步探索 [Ｊ]. 中國普外基礎與臨床雜志, 2009; 16(1): 70-74.
10.	Davila RE, Rajan E, Adler D, et al. ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer [Ｊ]. Gastrointest Endosc, 2005; 61(1): 1-7.
11.	Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer [Ｊ]. Int J Colorectal Dis, 2000; 15(1): 9-20.
12.	Rafaelsen SR, Srensen T, Jakobsen A, et al. Transrectal ultrasonography and magnetic resonance imaging in the staging of rectal cancer. Effect of experience [Ｊ]. Scand J Gastroenterol, 2008; 43(4): 440-446.
13.	Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85-118.
14.	Coussens LM, Werb Z. Inflammation and cancer [Ｊ]. Nature, 2002; 420(6917): 860-867.
15.	Renckens R, Roelofs JJ, Knapp S, et al. The acute-phase response and serum amyloid A inhibit the inflammatory response to Acinetobacter baumannii Pneumonia [Ｊ]. J Infect Dis, 2006; 193(2): 187-195.
16.	Kokubun M, Imafuku Y, Okada M, et al. Serum amyloid A (SAA) concentration varies among rheumatoid arthritis patients estimated by SAA/CRP ratio [Ｊ]. Clin Chim Acta, 2005; 360(1-2): 97-102.
17.	Tolson J, Bogumil R, Brunst E, et al. Serum protein profiling by SELDI mass spectrometry: detection of multiple variants of serum amyloid alpha in renal cancer patients [Ｊ]. Lab Invest, 2004; 84(7): 845-856.
18.	Michaeli A, Finci-Yeheskel Z, Dishon S, et al. Serum amyloid A enhances plasminogen activation: implication for a role in colon cancer [Ｊ]. Biochem Biophys Res Commun, 2008; 368(2): 368-373.
19.	Miwata H, Yamada T, Okada M, et al. Serum amyloid A protein in acute viral infections [Ｊ]. Arch Dis Child, 1993; 68(2): 210-214.
20.	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.
21.	吳俊華, 汪曉東, 高強, 等. 64排多層螺旋CT和血清淀粉樣蛋白A聯合評估下段直腸癌對手術方案選擇的影響 [Ｊ]. 中國普外基礎與臨床雜志, 2009; 16(2): 156-161.

1. ASGE Standards of Practice Committee, Gan SI, Rajan E, et al. Role of EUS [Ｊ]. Gastrointest Endosc， 2007;　66(3): 425-334.
2. Bipat S, Glas AS, Slors FJ,　 et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis　 [Ｊ].　 Radiology，　 2004;　232(3): 773-783.
3. Glojnaric＇ I, Casl MT, Simic＇ D, et al. Serum amyloid A protein (SAA) in colorectal carcinoma [Ｊ]. Clin Chem Lab Med, 2001; 39(2): 129-133.
4. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound [J]. Dis Colon Rectum, 1985; 28(1): 42-46.
5. Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual　[Ｍ]. 6th ed. New York (NY): Springer-Verlag, 2002: 113-124.
6. 李立. 結直腸癌外科應用技術的規范與創新(一) [Ｊ]. 中國普外基礎與臨床雜志, 2006; 13(1): 106-109.
7. 李立. 結直腸癌外科應用技術的規范與創新(二) [Ｊ]. 中國普外基礎與臨床雜志, 2006; 13(2): 222-226.
8. 蔡三軍. 直腸癌的外科治療進展 [Ｊ]. 中國癌癥雜志, 2004; 14(5): 410-414.
9. 汪曉東，呂東昊，曾天芳, 等. 多學科協作診治模式下結直腸癌術前輔助檢查系統的臨床應用初步探索 [Ｊ]. 中國普外基礎與臨床雜志, 2009; 16(1): 70-74.
10. Davila RE, Rajan E, Adler D, et al. ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer [Ｊ]. Gastrointest Endosc, 2005; 61(1): 1-7.
11. Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer [Ｊ]. Int J Colorectal Dis, 2000; 15(1): 9-20.
12. Rafaelsen SR, Srensen T, Jakobsen A, et al. Transrectal ultrasonography and magnetic resonance imaging in the staging of rectal cancer. Effect of experience [Ｊ]. Scand J Gastroenterol, 2008; 43(4): 440-446.
13. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85-118.
14. Coussens LM, Werb Z. Inflammation and cancer [Ｊ]. Nature, 2002; 420(6917): 860-867.
15. Renckens R, Roelofs JJ, Knapp S, et al. The acute-phase response and serum amyloid A inhibit the inflammatory response to Acinetobacter baumannii Pneumonia [Ｊ]. J Infect Dis, 2006; 193(2): 187-195.
16. Kokubun M, Imafuku Y, Okada M, et al. Serum amyloid A (SAA) concentration varies among rheumatoid arthritis patients estimated by SAA/CRP ratio [Ｊ]. Clin Chim Acta, 2005; 360(1-2): 97-102.
17. Tolson J, Bogumil R, Brunst E, et al. Serum protein profiling by SELDI mass spectrometry: detection of multiple variants of serum amyloid alpha in renal cancer patients [Ｊ]. Lab Invest, 2004; 84(7): 845-856.
18. Michaeli A, Finci-Yeheskel Z, Dishon S, et al. Serum amyloid A enhances plasminogen activation: implication for a role in colon cancer [Ｊ]. Biochem Biophys Res Commun, 2008; 368(2): 368-373.
19. Miwata H, Yamada T, Okada M, et al. Serum amyloid A protein in acute viral infections [Ｊ]. Arch Dis Child, 1993; 68(2): 210-214.
20. 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.
21. 吳俊華, 汪曉東, 高強, 等. 64排多層螺旋CT和血清淀粉樣蛋白A聯合評估下段直腸癌對手術方案選擇的影響 [Ｊ]. 中國普外基礎與臨床雜志, 2009; 16(2): 156-161.

《中國普外基礎與臨床雜志》

經直腸超聲聯合血清淀粉樣蛋白A術前評估中低位直腸癌與手術決策的隨機對照試驗

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《中國普外基礎與臨床雜志》

經直腸超聲聯合血清淀粉樣蛋白A術前評估中低位直腸癌與手術決策的隨機對照試驗

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