2014-10-09BrownG规范.ppt

本作品采用知识共享署名-非商业性使用 2.5 中国大陆许可协议进行许可。 专业交流 模板超市 设计服务 NordriDesign中国专业PowerPoint媒体设计与开发 本作品的提供是以适用知识共享组织的公共许可（ 简称“CCPL” 或 “许可”） 条款为前提的。本作品受著作权法以及其他相关法律的保护。对本作品的使用不得超越本许可授权的范围。 如您行使本许可授予的使用本作品的权利，就表明您接受并同意遵守本许可的条款。在您接受这些条款和规定的前提下，许可人授予您本许可所包括的权利。 查看全部… MRI评估低位直肠癌及MR肿瘤消退分级 Prof. Gina Brown 第24届上海长海国际肛肠外科周 2014.9 低位直肠癌测量 Sagittal T2WI show distance from the anal verge in and rectal tumors Low rectal 5 cm; Midrectal 5–10 cm; Upper rectal 10 cm Similar measurement to sigmoidoscopy Distance Upper Middle Lower 解剖 At the anorectal junction, the muscularis propria changes: The circular layer thickens and becomes the internal sphincter(IS) External sphincter (ES) complex is composed of the continuation of the inferior portion of the levator animuscle (L) and the puborectalis muscle (PBR) Radiology: Volume 268: Number 2—August 2013 T Staging T1 confined to the mucosa and submucosa T2 tumors invade the muscularis propria T3 lesions extend beyond Radiographics: 390 March-April 2012 MR扫描技术非常重要 Most staging failures occur in the differentiation between T2 and T3 lesions The use of thicker sections and lower resolution techniques Desmoplastic reaction compared with tumor Technique is important rectal contrast material The use of rectal contrast material is controversial May alter the distance between the tumor and the mesorectal fascia Do not arise if an appropriate amount (60–100 mL) of warm US gel is used valuable: with polypoid tumors (eg, villous adenomas), small rectal tumors (3 cm), or a history of prior therapy (eg, partial resection or radiation therapy). 低位直肠影像技术 Low rectal tumors are associated with higher rates of positive CRM higher local recurrence rates, and poorer survival This is largely due to anatomic considerations ：the mesorectal envelope tapers downward 直肠系膜逐渐变细 TME手术是否安全 耻骨直肠肌是否侵犯？ Black ：TME Green ： with intersphincteric resection Dashed ：conventional APR Gray ：extralevator APR TME手术是否安全 CRM Clear CRM Susp