超声内镜联合螺旋CT检查对胃癌治疗前TNM分期的临床价值  

The accuracy of the endoscopic ultrasonography combined with spiral CT on the diagnosis and the staging in patients with gastric cancer

作　　者：吴琼[1] 施敏[1] 惠萍萍[1] 王霆[1] 孟文颖[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：《临床消化病杂志》2016年第1期1-4,共4页Chinese Journal of Clinical Gastroenterology

基　　金：国家自然科学基金(No:81472242);上海市医学重点学科建设资金资助(No:ZK2012A05);上海市卫生计生委科研课题资助(No:20134100);上海市科委自然基金(No:14ZR1431600);上海市科学技术委员会课题基金(No:15411971000)

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,以协助临床治疗方案的选择。[方法]304例行外科手术治疗的胃癌患者,于术前1周行EUS和腹部螺旋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。[结果]EUS联合腹部螺旋CT对胃癌术前TNM分期准确率,T分期83.22%,N分期75.66%,M分期97.70%。与术后病理结果比较,EUS对胃癌T1、T2、T3、T4分期的准确率分别为85.71%、78.26%、82.39%、86.79%,总准确率为83.22%;EUS对胃癌N0、N1、N2、N3分期的准确率分别为76.92%、73.68%、58.89%、31.71%,总准确率为65.46%。螺旋CT对胃癌N0、N1、N2、N3分期的准确率分别为82.05%、72.63%、74.44%、70.73%,总准确率为75.33%。EUS与螺旋CT对于N2、N3、M1分期的判断准确性比较,差异具有统计学意义(分别为X^2=4.900,P=0.039;X^2=12.495,P=0.001;X^2=9.143,P=0.005)。[结论]EUS对胃癌术前T分期、N0分期、N1分期具有较高的临床价值;螺旋CT检查对胃癌术前N2、N3、M1分期准确性较高;EUS联合CT检查,可明显提高术前TNM分期准确性,具有较好的临床应用价值。[Objective]To evaluate the accuracy of endoscopic ultrasonography（EUS）combined with spi- ral CT on the diagnosis and the staging in patients with gastric cancer before operation. [Methods]To ob- serve the tumor infiltration depth（T）, lymph node metastasis （N）, and distant metastases （M） stages, EUS and abdominal spiral CT examination were performed on 304 cases with gastric cancer 1 week before operation. The accuracy was compared with the finding of pathological examination after operation. [Results] Comparing with postoperative pathological results, the accuracy rate of EUS for gastric cancer of T1,T2, T3,T4 were 85.71%,78.26%,82.39%,78.26% ,the t average was 83.22%. The accuracy rate of EUS for N0,N1,N2,N3 were 76.92%,73.68%,58.89o//00,73.68%,the average was 65.46%. the accuracy rate of Spiral CT for the N0,N1,N2,N3 were 82.05% ,72.63%,74. 44% and 70.73% ,the average was 75.33%. Generally,the accuracy rate of preoperative were：T：83. 22% ,N.75.66% ,M.97.70%. Compared with spiral CT,EUC showed no statistically significant difference in N0,Nl,and M0 finding. But had statistically significant difference in N2 and N3,M1 finding（respectively,χ2 =4. 900,P：0. 039;χ2=12. 495,P=0. 001;χ2= 9. 143,P=0. 005）. [Conclusion]Before operation of gastric cancer, EUS has high value in finding T, NO, N1, Spiral CT has high value on N2 and N3, M1 finding. Combined CT and EUS can obviously improve the accuracy of TNM staging before operation,which has good clinical application value.

关 键 词：胃癌 超声内镜 螺旋CT 

分 类 号：R735.2[医药卫生—肿瘤]