超声内镜诊治胃癌的评价

Evaluation of EUS in Diagnosis and Treatment for Gastric Cancer

目的评价超声内镜(EUS)诊断术前胃癌浸润深度(T分期)的准确性,为胃癌手术和内镜下粘墨切除提供参考依据。方法术前使用线阵型超声内镜对业经病理证实的胃癌52例进行检查,行TNM分期,将术前检查结果与术后病理结果进行比较。结果52例均行手术治疗。与术后病理结果对比,EUS的T分期总准确率为65.4%,T1、T2、T3、T4分期的准确率分别为4/5、7/12、7/19和16/16,其中EUS准确诊断早期胃癌4例,但1例胃黏膜下层癌,被诊断为固有肌层癌。EUS对手术可切除的预测为75.0%,但T4期胃癌手术切除率仅为25.0%(4/16)。结论EUS能准确判断胃癌浸润深度和早期胃癌,对指导内镜下黏膜切除术有很大帮助。对T4期胃癌患者,虽然诊断准确性较高,但对指导根治性手术的意义不大。

Objoctive To evaluate the diagnostic accuracy of endoscopic ultrasonography （EUS） against preoperative invasion depth of gastric cancer （T staging）. Mothods 52 gastric cancer sufferers that have been confirmed by pathology were examined before operation with EUS through TNM staging, and the preoperative examination results were analyzed and compared with post-operative pathological results. Results All the 52 patients were treated by surgery. Compared to post-operative pathological results, the overall accuracy of stage T of EUS is 65.4%, and the accuracy of T1, T2, T3 and T4 is 80.0%, 58.3%, 36.8% and 100.0% respectively; and its sensibility to the prediction of operational respectability is 75.0%. 4 cases of early gastric cancer （EGC） diagnosed by EUS were proved by the operation. However, I case of gastric submucosa cancer was diagnosed as muscularis propria （MP） cancer by EUS. Surgical removable rate of gastric cancer at stage T4 was just 25.0%（4/16）. Con- clusion EUS bears high accuracy to diagnose the invasion depth of gastric cancer. It does much favor to instruct endoscopic mucosal resection （EMR） because EGC could be judged relatively accurately. To gastric cancer sufferers at stage T4, the instructive significance of EUS to radical operation is little.