胃镜及CT检查对进展期胃癌手术可切除性的探讨

Study on resectability of advanced gastric cancer based on gastroscopic and CT examination

目的探讨胃镜结合CT检查对进展期胃癌的术前分期及手术治疗的临床指导意义。方法对182例进展期胃癌的术前胃镜并CT分期与手术结果进行对比。结果胃镜活检低(未)分化腺癌和黏液腺癌手术切除率(64.1%)较低,弥漫浸润型胃癌的切除率(6.7%)明显低于肿块型(66.7%)和溃疡型(61.8%);CT分期总准确率为91.21%,CT诊断对胃周脏器受侵和(或)转移的敏感性为72.22%,CT对淋巴结分期的准确率为74.2%,敏感性为74.1%,特异性为74.3%,CT诊断对淋巴结分组比较模糊。结论胃镜在进展期胃癌定性诊断方面有不可取代的优势,对进展期胃癌的大体分型和活检组织学诊断及治疗方式有指导意义。CT诊断对进展期胃癌的临床分期准确性对周围脏器的侵犯、转移及淋巴结转移的诊断均有很高的价值;CT对手术切除情况的判断优于胃镜检查。术前行CT检查,对手术治疗有重要指导意义。

Objective To explore the use of gastroscopy and CT for staging and clinical guiding to the surgical therapy of advanced gastric cancer. Methods The preoperative gastroscopic and CT classification and the results of operative classfication of 182 cases of advanced gastric carcinoma were compared. Results The resection rate for low and undifferentiated adenocarcinoma and mucinous carcinoma on gastroscopic biopsy was low （64. 1% ） , and the rate for diffuse infiltrative gastric carcinoma （6.7 % ） was significantly lower than that of mass tumor type （ 66.7 % ） and ulcerative type （ 61. 8 % ）. The total accuracy rate of CT staging was 91.21%. Sensitivity rate of CT diagnosis of perigastric invasion and/or metastasis was 72.22%. For lymph node staging the accuracy rate of CT was 74. 2% , sensitivity rate was 74. 1% and specificity rate was 74.3% . CT diagnosis of lymph node groups was blur. Conclusions Gastroscopy has an unreplaceable role in the final diagnosis of advanced gastric cancer and has significance for gross tumor grading, histologic biopsy diagnosis can be as a guide to dicide the treatment modality of advanced gastric cancer. CT has high degree of value for accuracy of clinical staging, and diagnosis of invasion of adjacent organs and lymph node metastasis. CT is superior to gastroscopy for judgement of resectability. Therefore, preoperative CT is a valuable guide for surgical treatment of advanced gastric cancer.