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目的：探讨64 层螺旋CT增强扫描检查对结直肠癌术前T 分期的临床应用价值。方法：对2012 年3 月～10 月在我院行64 层螺旋CT 增强扫描，术后病理证实为结直肠癌的173 例患者的CT 成像结果进行回顾性分析。将CT 分期的结果与术后病理分期结果进行一致性比较分析，并对肿瘤长度、CT 值、病理分型等进行相关分析及比较。结果：CT 术前T 分期：T1-2 期、T3 期、T4 期的灵敏度分别为60.90%（14/23）、89.92%（116/129）、95.24%（20/21），特异度为95.33%（143/150）、77.27%（34/44）、96.05% （146/152），准确率为66.67%（14/21）、92.01%（116/126）、76.92%（20/26），诊断一致性检验结果Kappa=0.685, P =0.000, P＜0.05，有统计意义。不同病理分期中肿瘤长度及不同病理分型中肿瘤CT 值方差分析结果，P＜0.05，有统计意义。不同病理分期中CT值方差分析结果，P＞0.05，没有统计意义。病理分期与病理分型的X2检验结果，P＜0.05，有统计意义。对T1-2过分期和T3 低分期两组病例进一步分析，发现增强扫描后强化程度、管壁僵硬和浆膜不光整有助于鉴别T1-2 过分期和T3 期低分期，能够提高T1-2 期和T3 期的准确性。结论：64 层螺旋CT 增强扫描多种征象的相互结合有助于提高结直肠癌术前分期的准确性，对临床诊治有重要价值。

英文摘要:

Objective:To assess the value of 64-slice spiral CT colonography (CTC) in preoperative T staging of colorectal carcinomas.Methods:We retrospectively analyzed 173 patients with rectal cancer, who had pretreatment CT and curative surgery between March and October 2012. The results of CT preoperative T staging and pathological T staging of tumors. The correlation of tumor length, CT value, pathological type and so on were analyzed.Results:For CT evaluation of T1-2, T3, T4 staging, the sensitivity were 60.90%（14/23）, 89.92%（116/129）and 95.24%（20/21）, specificity were 95.33%（143/150）, 77.27%（34/44）, 96.05%（146/152） and accuracy were 66.67%（14/21）, 92.01%（116/126）and 76.92%（20/26）. The statistically significant results of the Kappa test are Kappa=0.685, P=0.000 and P＜0.05. The statistically significant results of tumor length in pathological staging and the CT value in pathological type are P＜0.05. The results of CT value in pathological staging is P > 0.05. And the difference is not statistically significant. The statistically significant X2 test results of pathological staging and pathological type are P<0.05. On the two groups of T1-2 over-period and T3 low installments were further analyzed and found that the degree of enhancement enhanced scan, wall stiffness and unflatness of chorion help to identify T1-2 over-period and T3 low installments, and can improve the T1-2 and T3 staging of accuracy.Conclusion:Thecombination of 64-slice CT scan multiple signs of colorectal cancer help to improve the accuracy of preoperative staging for clinical diagnosis and treatment has an important value.

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