胃癌术前螺旋CT检查价值的探讨

THE USE OF RESULTS OF PREOPERATIVE SPIRAL DETECTION IN GUIDING OPERATIONS ON PATIENTS WITH GASTRIC CARCINOMA

目的 探讨螺旋CT对胃癌手术的指导价值。方法 对 98例手术治疗患者 ,术前行螺旋CT平扫及增强扫描、进行CT分期。将CT资料与手术病例资料对照。结果 98例胃癌中增生型 5 6例、溃疡型 2 7例、浸润型 15例。肿瘤呈较明显强化 ,接近胃黏膜强化程度。侵及食管者 19例 ,侵及胰腺 6例 ,腹腔种植转移者 8例 ,其中 2例伴有中量腹水。本组病例根据病变部位均采用所需体位扫描 ,病变区胃囊充盈良好、在低密度水的衬托下辅以强化 ,病灶显示清楚 ;特别对淋巴结肿大的检出更为明显 ,本组对短径≥ 1cm肿大淋巴结转移的检出率 6 4 .39% (4 7/ 73)。按照新TNM分期标准 ,本组CTTNM分期 (CTNM ) 84例正确 ,总准确率为 85 .71% (84 / 98) ,Ⅳ～Ⅱ期病例行根治手术比率分别 7.4 1% (2 / 2 7)、72 .35 % (34/ 4 7)和 10 0 % (2 4 / 2 4 )。结论 体位腹部螺旋CT扫描 ,结合增强扫描可清楚显示病变及其与毗邻结构关系 ,对胃癌手术具有重要指导意义。

Objective To explore the use of preoperative spiral CT detection to guide operations on patients with gastric carcinoma.Methods 98 cases to undergo operations received spiral CT scanning and enhanced scannings,and TNM of CT scanning was also made.Results 56 cases of proliferative carcinoma,27 cases of ulcerative carcinoma and 15 cases of infiltrative carcinoma were detected.The degrees of potentialization of tumors were similar to those of gastric mucosa.Esophagus was eroded in 19 cases,pancreas was eroded in 6 cases and intra-abdominal implantation was transferred in 8 cases.Ascites were discovered in 2 cases.Foci could be shown clearly under the condition of good gastric punch filling,low density water and potentialization of tumors.Lymphadenectasis could be effectively detected.The detective rate of lymphadenectasis with its short diameter being longer than 1cm was 64.39%(47/73).According to the new standard of TNM,thd detection coincidence rate was 85.7%(84/98).The radical surgical rates at the stages Ⅱ～Ⅳ were 7.41%(2/27),72.35%(34/47) and 100% (24/24) respectively.Conclusion Spiral CT scanning can be used to guide operation when enhanced to show the structural relationship between foci and their adjacent organs.