内镜超声检查和多层螺旋CT对胃癌术前T、N分期的比较研究

A comparative study of endoscopic ultrasonography and multi-slice spiral CT in the preoperative TN staging of gastric carcinoma.

目的探讨内镜超声(endoscopicultrasonography,EUS)与多层螺旋CT(multi slicespiralCT,MSCT)在胃癌术前T、N分期中的临床应用价值。方法2000年10月至2002年5月,对89例活检证实的胃癌病人术前分别行内镜超声和多层螺旋CT检查,并与手术病理结果对照。结果EUS对胃癌术前T分期的准确率为75.6%,其中T176.5%,T268.8%,T384.4%,T464.7%;MSCT分别79.3%,58.8%,62.5%,90.6%和94.1%。两者差异无统计学意义(P>0.05)。EUS对胃癌术前N分期的准确率为57.5%,其中N095.8%,N145.8%,N232.0%;MSCT分别78.1%,70.8%,75.0%和88.0%。EUS和MSCT对胃癌淋巴结转移的敏感性分别为61.2%和91.8%。EUS对N0分期的准确率显著高于MSCT(P<0.05),MSCT对N和N2分期的准确率及淋巴结转移的敏感性均显著高于EUS(P<0.05,P<0.01,P<0.01)。结论内镜超声检查与多层螺旋CT对胃癌术前TN分期均有较高的准确性。

Objective To investigate the clinical significance of endoscopic ultrasonography (EUS) and multi-slice spiral CT (MSCT) in the preoperative T and N staging of gastric carcinoma.Methods Both EUS and MSCT were performed in 89 patients with gastric carcinoma proved by means of biopsy,and the results of EUS and MSCT were compared with surgical pathologic findings.Results The accuracy of EUS and MSCT in T staging was 75.6% (T_(1) 76.5%,T_(2) 68.8%,T_(3) 84.4%,T_(4) 64.7%,respectively) and 79.3%(T_(1)58.8%, T_(2)62.5%,T_(3)90.6%,T_(4)94.1%,respectively),and there was no statistical difference(P>0.05).The accuracy of EUS and MSCT in N staging was 57.5% (N_(0)95.8%,N_(1) 45.8%,N_(2)32.0%,respectively) and 78.1% (N_(0) 70.8%,N_(1) 75.0%,N_(2) 88.0%,respectively).The sensitivity for lymph node metastasis with EUS and MSCT was 61.2% and 91.8%,respectively.The accuracy of EUS in determining N_(0) stage was significantly higher than that of MSCT (P<0.05),whereas the accuracy for N and N_(2)staging and the sensitivity for lymph node metastasis with MSCT were significantly higher than those with EUS (P<0.05,P<0.01,P<0.01).Conclusion Both EUS and MSCT are highly accurate in the preoperative T and N staging of gastric carcinoma.