超声内镜联合CT检查对胃癌术前TNM分期价值.docVIP

超声内镜联合CT检查对胃癌术前TNM分期价值 　　[摘要] 目的：评价超声内镜（EUS）联合腹部CT检查对胃癌患者术前诊断和分期的准确性，以指导临床治疗方案的选择。方法：54例胃镜加活检病理确认（53例）和疑诊为胃癌但常规病理检查为阴性的患者（1例），术前1周同时行EUS、腹部螺旋CT检查，疑诊者同时行EUS引导下细针穿刺吸引术（EUS-FNA）以明确诊断。确定肿瘤侵犯的深度（T）、局部淋巴结转移（N）、周围及远处器官转移（M）等分期情况，并与手术及术后病理对照，以评价EUS联合CT对胃癌的诊断及TNM临床分期的准确性。结果：1例疑癌但病理阴性的患者行EUS-FNA术获得癌细胞。本组患者EUS对胃癌T分期的准确率分别为T1 83.33％、T2 72.73％、T3 75.00％和T4 72.73％。EUS对胃癌N分期的准确率分别为88.24％（N0）、66.67％（N1）、60.00％（N2）和28.57％（N3）。HCT对胃癌淋巴结转移判断的准确率分别为82.35%（N0），60.00%（N1），66.67%（N2），71.43%（N3），EUS及HCT对于N0和N1、N2的判断的准确率接近，而对于N3的判断，HCT较EUS有明显优势，P 　　[关键词] 胃癌；超声内镜；螺旋CT；癌症分期 　　[中图分类号] R735.2 [文献标识码] C[文章编号] 1674-4721（2011）06（b）-021-03 　　 　　Endoscopic ultrasonography associated with HCT in preoperative TNM staging of gastric cancer 　　LI Ji1, PENG Haixia1*, KUAI Rong1, ZHU Caisong2, JIN Yunfei1, CHU Yimin1, YANG Hua3, YANG Jing3, WANG Saiyu1,HONG Yi1 　　1.Endoscope Room, the Center Hospital of Changning District, Shanghai200336, China; 2.Department of Radiology, the Center Hospital of Changning District, Shanghai200336, China; 3.Department of Pathology, the Center Hospital of Changning District, Shanghai200336, China 　　[Abstract] Objective: To explore the clinical value of endoscopic ultrasonography (EUS) associated with HCT in preoperative staging of gastric cancer. Methods: EUS was performed in 54 patients and fine needle aspiration (FNA) was administrated to a suspicious patient. Helical CT scanning was performed in all of the patients. Compared the results of operation and pathology with those tumor staging by estimating the depth of tumor invasion (T), local lymph node metastasis (N) and metastasis to neighboring or remote organs (M) in order to estimate the accuracy of diagnosis and TNM staging. The accuracy of tumor-node-metastasis staging of gastric cancer by EUS and HCT was compared with postoperative pathologic findings. Results: In the suspicious patient specimen was successfully obtained by FNA under the guide of EUS with the pathological diagnosis of signet ring cell carcinom