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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T183.33%、T272.73%、T375.00%和T472.73%。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<0.05。对于M1即胃癌有远处转移的比较,EUS及HCT的准确率分别为30.00%(3/10),90.00%(9/10),HCT对M1的判断优于EUS,P<0.05。结论:EUS对胃癌术前T分期及N1分期具有较高的临床应用价值;而HCT对于远处淋巴结转移的分期及M分期的准确性较高,超声内镜联合HCT检查,可获得较准确的术前TNM分期,并指导选择治疗方案。
Objective: To evaluate the accuracy of preoperative diagnosis and staging of gastric cancer with endoscopic ultrasonography (EUS) and abdominal CT in order to guide the choice of clinical treatment options. Methods: Totally 54 cases were diagnosed by gastroscope plus biopsy (53 cases) and 1 case was suspected gastric cancer but routine pathological examination was negative. One week before operation, EUS and abdominal spiral CT were performed at the same time. EUS Guided fine needle aspiration (EUS-FNA) to confirm the diagnosis. Determine the depth of tumor invasion (T), local lymph node metastasis (N), peripheral and distant organ metastasis (M) and other stages, and surgery and postoperative pathology to evaluate EUS combined with CT in the diagnosis of gastric cancer and TNM clinical Staging accuracy. Results: One case of suspected cancer but negative in pathology was treated with EUS-FNA to obtain cancer cells. This group of patients with EUS gastric cancer T staging accuracy rates were T183.33%, T272.73%, T375.00% and T472.73%. The accuracy of EUS for gastric cancer staging was 88.24% (N0), 66.67% (N1), 60.00% (N2) and 28.57% (N3), respectively. The accurate rates of HCT in determining lymph node metastasis of gastric cancer were 82.35% (N0), 60.00% (N1), 66.67% (N2) and 71.43% (N3) respectively. The accuracy of EUS and HCT for N0 and N1 and N2 were close , While for the judgment of N3, HCT had obvious advantages over EUS, P <0.05. For M1, the distant metastasis of gastric cancer, EUS and HCT were 30.00% (3/10) and 90.00% (9/10) respectively. HCT was superior to EUS in determining M1, P <0.05. CONCLUSIONS: EUS has high clinical value in preoperative T stage and N1 stage of gastric cancer. However, the accuracy of HCT for staging and M staging of distant lymph node metastasis is high. Ultrasound endoscopy combined with HCT can obtain more accurate Preoperative TNM staging, and guide the choice of treatment options.