直 肠 癌 MDT讨论的.pptVIP

直 肠 癌 MDT讨论 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 病 例 特 点 女性 59岁 因“大便次数增多4月，便血2月”于2012年5月3日入院。 肠镜：距肛门10-7cm直肠见肿物呈不规则形突向肠腔，以右前壁为主。病理：乳头状腺癌。 腔内超声检查提示肿物侵及肠壁全层 。 CEA 37.5ng/ml，CA199 4.46u/ml。 胸部、上腹部CT(-) Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 影 像 学 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 治 疗 术中探查肝脏、胆、胰、脾、胃、小肠未见转移，直肠上动 脉脉根部及肠系膜下动脉根部未见肿大淋巴结,肿物位于腹膜 反折以下，游离乙状结肠系膜，见直肠后壁肠旁淋巴结肿 大，融合成团，与骶前有癌侵，电刀沿直肠系膜锐性分离开 粘连，切断直肠侧韧带，充分游离直肠,距腹膜反折以上 15cm切断乙状结肠下端，行乙状结肠左下腹造瘘。 （Miles) Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 病 理 术后病理回报：直肠隆起型低分化乳头状腺癌，肿物大小 3×2×0.7厘米，癌细胞侵及肠壁深肌层，断端净，肠系膜 淋巴结转移癌（1/13);直肠上动脉根部淋巴结未见癌（0/1) Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 入院诊断 直肠癌术后ⅢA期(pT2N1aM0)? 直肠癌术后ⅢC期(pT4bN1aM0)? Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 问题 术前评估是否充分？ 腔内超声评价周围淋巴结准确性？ 腔内超声和盆腔MRI各有何优势？ 手术？ 同步放化疗后+手术？ 下一步治疗 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 辅助检查 MRI适应症同CT，以下首选 1）直肠癌术前分期 2）结直肠癌肝转移灶的评价 3）怀疑腹膜及肝被膜下病灶 超声 推荐直肠腔内超声或内镜超声检查为中低位直肠癌诊断及分期的常规检查 2010结直肠癌诊疗规范 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created