经腹体表超声对食管胃结合部腺癌术前评估的应用价值  

Value of transabdominal ultrasoud in preoperative assessment of adenocarcinoma of the esophagogastric junction

作　　者：丁柏成 徐阿曼[1,2] 叶早群[3] 韩文秀[2] 韦之见[2] 陈章明[2] 袁笑[1] 刘虎[1] 

机构地区：[1]安徽医科大学第四附属医院普外科,安徽省合肥市230000 [2]安徽医科大学第一附属医院普外科,安徽省合肥市230000 [3]安徽医科大学第一附属医院超声科,安徽省合肥市230022

出　　处：《世界华人消化杂志》2016年第24期3612-3617,共6页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.81572350~~

摘　　要：目的探究经腹体表超声（transabdominal ultrasoud,TUS）在食管胃结合部腺癌（adenocarcinoma of esophagogastric junction,AEG）术前评估的临床应用价值.方法2014-12/2016-05接受手术切除的65例经胃镜初诊的AEG患者,所有研究对象均于术前行TUS和电子计算机断层扫描（computed tomography,CT）检查,结合术后病理进行分析对比.结果参照Siewert分型,TUS对AEG临床分型诊断正确率为90.8%,其中Ⅰ型85.7%,非Ⅰ型92.2%.TUS及CT对AEGT分期的诊断准确率分别为33.8%、63.1%,其中T1-3 29.4%、52.9%;T4 35.4%、66.7%,两者在T分期诊断中差异有统计学意义（χ~2=10.85,P=0.001）,但在术前诊断为低分化的腺癌的AEG患者中,TUS与CT在T分期诊断中差异无统计学意义（χ~2=0.26,P=0.61）.TUS及CT对AEG N分期的诊断准确率分别为38.5%、50.8%,其中N＋0 87.5%、91.7%;N 9.8%、26.8%,两者在N分期诊断中差异无统计学意义（χ~2=0.07,P=0.79）.TUS及CT对AEG M分期的诊断一致.结论术前TUS能准确判断AEG的分型,有助于临床制定手术路径;TUS对AEG的N、M分期有较高的临床应用价值;当AEG患者术前胃镜初诊为低分化腺癌时,TUS和CT均可用于术前TNM分期.AIM To assess the value of transabdominal ultrasound（TUS） in the preoperative assessment of adenocarcinoma of the esophagogastric junction（AEG）.METHODS A total of 65 patients who underwent TUS and computed tomography（CT） preoperatively and were pathologically diagnosed with AEG after surgery from December 2014 to May2016 were included in this study.The TUS or CT results were compared with pathological findings.RESULTS With regard to Siewert’s classification,the diagnostic accuracy of TUS in AEG was 90.8%（85.7%for type Ⅰ and 92.2%for non-type Ⅰ）.The accuracy of TUS and CT in T-staging of AEG was 33.8%and 63.1%,respectively,and there was a significant difference between the two diagnostic modalities（P 〈 0.05）,although there was no significant difference in accuracy of N-staging and M-staging between CT and TUS（P 〉 0.05）.For those who were preoperatively diagnosed with poorly differentiated adenocarcinoma,there was no significant difference in the accuracy of T-staging of AEG between TUS and CT（P 〉0.05）.CONCLUSION TUS is an available tool for the typing of AEG,which is useful for deciding surgical approaches.TUS has high value in preoperative N- and M-staging,and for patients who are preoperatively diagnosed with poorly differentiated adenocarcinoma,both TUS and CT can be used in preoperative TNM-staging.

关 键 词：经腹体表超声 食管胃结合部腺癌 分型 TNM分期 分化程度 

分 类 号：R735[医药卫生—肿瘤]