提高胃肠道肿瘤临床分期诊断正确率的意义及对策  

Importance and strategies of enhancing diagnostic accuracy in clinical staging for gastrointestinal carcinoma

作　　者：苏向前[1,2] 杨宏[1,2] 

机构地区：[1]北京大学肿瘤医院 [2]北京市肿瘤防治研究所胃肠肿瘤微创外科 恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国实用外科杂志》2015年第1期57-61,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.81272766);国家高技术研究发展计划(863)(No.2014AA020603);首都临床特色应用研究(No.Z121107001012130);北京市医院管理局临床医学发展专项经费(No.XM201309)

摘　　要：在制定胃肠道肿瘤的手术方案和治疗计划时,准确评估肿瘤的浸润深度、淋巴结转移和远处转移情况至关重要。若低估肿瘤的临床分期可能导致切缘癌残留,或因术前漏诊远处转移而进行不必要的探查手术,而过分高估临床分期则会使原本可能根治切除的病例错误地接受姑息治疗而丧失治愈机会。NCCN指南推荐使用多种检查手段进行胃癌和结直肠癌的术前评估,如腹盆腔CT和胸部CT,内镜超声,经直肠超声,MRI,PET-CT等。由于单独采用任何一种影像检查均有技术局限性,故推荐综合应用多种检查手段以提高术前分期的准确性。Accurate assessment of local tumor depth invasion （T）, regional lymph node invasion （N）, and distant metastases （M） is crucial to appropriate surgical and treatment planning for gastrointestinal carcinoma. Understaging of the disease may lead to positive resection margins or unnecessary laparotomy if metastases were not identified on preoperative imaging. Overstaging a patient may lead to ineffective care if a potentially curative patient is incorrectly categorized as a palliative patient. National Comprehensive Cancer Network （NCCN） practice guidelines for gastric cancer and colorectal cancer suggest using a variety of techniques as part of the workup, including CT of abdomen, pelvis and chest imaging, endoscopic ultrasound, endorectal ultrasound, MRI, PET-CT and so on. As routine use of each imaging modalities has limitations, combined utilization should be recommended for preoperative assessment.

关 键 词：胃癌 结直肠癌 临床分期 影像学检查 

分 类 号：R6[医药卫生—外科学]