腹腔镜术中超声确定胃癌TNM的临床研究  

Clinical study on determination of TNM in gastric cancer by laparoscopic ultrasonography

作　　者：刘超[1] 菅敏 毛伟征[1] 齐宏[1] 薛英明 LIU Chao;JIAN Min;MAO Wei-zheng;QI Hong;XUE Ying-ming(Second Department of General Surgery,Eastern Hospital of Qingdao Municipal Hospital,Qingdao 266071,China;Department of Laboratory Medicine,Qingdao Women and Children’s Hospital,Qingdao 266034,China)

机构地区：[1]青岛市市立医院东院普外二科,山东青岛266071 [2]青岛市妇女儿童医院检验科,山东青岛266034

出　　处：《中国现代普通外科进展》2019年第8期593-597,601,共6页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨腹腔镜术中超声(LUS)确定胃癌TNM的效果。方法:收集2015年9月-2017年10月青岛市市立医院东院普外科经胃镜病理组织活检证实的118例胃癌患者,患者术前常规评估心肺功能,完善术前准备,手术医师先完成腹腔镜检查,之后通过腹壁上的通道将腹腔镜探头放入腹腔,在腹腔镜图像的指导下进行超声扫描,对肿瘤的TNM分期做出评价。术后对切除标本行病理学分期,对T、N、M分期统计量行一致性分析,对两种方法的符合率进行比较。结果:LUS对胃癌T1~T4分期诊断的灵敏度和特异性分别为75.0%(9/12)、90.65%,75.0%(12/16)、92.16%,71.4%(5/7)、83.61%,92.8%(77/83)、96.67%。对胃癌N0~N3分期诊断的灵敏度及特异性分别为70.6%(24/34)、91.25%,83.3%(40/48)、78.26%,72.4%(21/29)、91.7%,71.43%(5/7)、97.1%。对二者行一致性比较的Kappa值为0.637,结果较为满意。LUS对胃癌远处转移(M)的判断总准确率为99.1%(117/118),其中M0 100%,M1 53.85%。结论:LUS检查对胃癌临床分期准确性较高,能精准分型,并能识别淋巴结远处转移。Objective:To investigate the effect of 1aparoscopic ultrasound(LUS)in the determination of TNM in gastric cancer.Methods:From September 2015 to October 2017,118 patients with gastric cancer confirmed by gastroscopic pathological biopsy were collected from the Eastern Hospital of Qingdao Municipal Hospital.Before the operation,the cardiopulmonary function was assessed routinely and the preoperative preparation was improved.The surgeon completed the laparoscopic examination first,then put the laparoscopic probe into the abdominal cavity through the abdominal wall passage,and performed ultrasound scanning under the guidance of the laparoscopic image to evaluate the TNM staging of the tumors.Pathological staging was performed on the resected specimens after operation,and consistency analysis was made on T,N and M staging statistics.The coincidence rates of the two methods were compared.SPSS13.0 was used for statistical analysis.Chi-square test and correlation analysis were used for statistical analysis,P<0.05 had statistical significance.Results:1.The sensitivity and specificity of laparoscopic ultrasonography(LUS)in staging T1-T4 gastric cancer were 75.0%(9/12),90.65%,75.0%(12/16),92.16%,71.4%(5/7),83.61%,92.8%(77/83)and 96.67%,respectively.The sensitivity and specificity of N0-N3 staging for gastric cancer were 70.6%(24/34),91.25%,83.3%(40/48),78.26%,72.4%(21/29),91.7%,71.43%(5/7)and 97.1%,respectively.The Kappa value was 0.637 for the consistency comparison between the two rows,and the results were satisfactory.2.The overall accuracy rate of LUS for distant metastasis(M)of gastric cancer was 99.1%(117/118),of which M0 100%and M1 53.85%.Conclusion:1.Laparoscopic ultrasonography has become an important means of staging gastric cancer.LUS can accurately classify gastric cancer,has obvious advantages in T staging of gastric cancer,and can identify distant lymph node metastasis.2.The accuracy of LUS in clinical staging of gastric cancer has been significantly improved,which is worthy of clinical promotion.

关 键 词：胃肿瘤 腹腔镜超声 TNM分期 

分 类 号：R735.2[医药卫生—肿瘤]