超声胃镜联合螺旋CT检查对胃癌个体化治疗的指导意义  

Guiding significance of endoscopic ultrasonography combined with spiral CT examination in individualized treatment of patients with gastric cancer

作　　者：吴琼[1] 施敏[1] 惠萍萍[1] 王霆[1] 魏珏[1] 王玉刚[1] 

机构地区：[1]上海交通大学医学院附属同仁医院消化内科,上海200336

出　　处：《实用临床医药杂志》2015年第21期24-28,37,共6页Journal of Clinical Medicine in Practice

基　　金：国家自然科学基金资助项目(81472242);上海市医学重点学科建设基金资助项目(ZK2012A05);上海市科委自然基金(14ZR1431600);上海市卫计委科研课题(20134100)

摘　　要：目的评价超声内镜(EUS)联合螺旋CT检查对胃癌患者术前诊断和分期的准确性。方法 601例胃癌患者(失随访7例),于治疗前1周行EUS和(或)螺旋CT检查,确定肿瘤浸润深度(T)、淋巴结转移(N)、远处转移(M)等分期情况,并与术后病理TNM分期进行对照,以评价EUS联合螺旋CT对胃癌TNM分期的准确性。随访1年,评估患者1年生存率、复发率等指标。结果与术后病理结果比较,EUS联合螺旋CT对胃癌术前TNM分期准确率分别为:T分期83.28%,N分期76.21%,M分期99.04%。N分期和M分期方面,联合组与EUS组、螺旋CT组比较,差异有统计学意义(P<0.005)。总体1年生存率86.7%,复发率4.3%,无瘤中位数生存期32.6月,中位数住院时间12 d,早期胃癌的5年生存率96.43%。结论EUS联合螺旋CT检查对胃癌术前TNM分期准确性较高,以此指导患者的个体化治疗对提高患者1年生存率、降低1年复发率具有较好的临床应用价值。Objective To evaluate the accuracy of the diagnosis and the staging of endoscopic ultrasonography（ EUS） combined with spiral CT in patients with gastric cancer. Methods A total of 601 patients with gastric carcinoma（ 7 cases lost） were checked by EUS and（ or） spiral CT one week before treatment in order to determine the tumor infiltration depth（ T）,lymph node metastasis（ N） and distant metastases（ M）,and these results were compared with postoperative pathologic results to evaluate the accuracy of TNM by EUS and spiral CT. After follow- up of one year,one year survival rate and recurrence rate were evaluated. Results Compared with postoperative pathological results,the rate of TNM by EUS with spiral CT were as follows： T phase was 83. 28%,N phase was76. 21%,and M phase was 99. 04%. There were significant differences in N phase and M phase among three groups（ χ2= 13. 479,P〈 0. 005）. One year survival rate was 86. 7%,the recurrence rate was 4. 3%,the median disease- free survival time was 32. 6 months,the median number of days in hospital was 12 days,5- year survival rate of early gastric cancer was 96. 43%. Conclusion EUS combined with spiral CT has a higher accuracy of TNM staging before operation,and it has a good clinical application value in improving one year survival rate and reducing one year recurrence rate.

关 键 词：超声内镜 螺旋CT 胃癌 治疗 

分 类 号：R735.2[医药卫生—肿瘤]