彩色多普勒超声鉴别诊断胃间质瘤与胃癌

Color Doppler ultrasonography in differential diagnosis of gastric stromal tumor and carcinoma

目的比较胃间质瘤和胃癌的经腹超声表现,探讨超声的鉴别诊断价值。方法回顾性分析经手术病理证实的胃间质瘤(24例)及胃癌(26例)患者的术前超声表现,包括病灶的分布、形态、血流以及周边淋巴结转移。结果胃间质瘤主要发生于胃底、体部(n=16),超声表现为膨胀性生长的低回声肿块,形态规则,有包膜,部分内部可出现液化坏死,血供较丰富,未探及周边肿大淋巴结;胃癌主要发生于胃窦部(n=17),大部分呈沿胃壁浸润性生长、不规则增厚的低回声病灶,边界不清,可包绕胃腔生长呈"假肾征",血供较少,可见淋巴结肿大。二者在发生部位、形态、内部回声以及周边淋巴结转移的发生率差异有统计学意义(P<0.05),而彩色血流信号丰富程度差异无统计学意义(P>0.05)。结论经腹超声检查能够较为准确地鉴别胃间质瘤和胃癌。

Objective To investigate the value of transabdominal ultrasonography in differential diagnosis of gastric stromal tumor and carcinoma through comparing the ultrasonic appearances of tumors.Methods The preoperative manifestations of tumor,including lesion distributions,morphology,color flow signals and lymph metastasis were reviewed retrospectively in 24 patients with gastric stromal tumors and 26 patients with gastric carcinomas.All the patients were confirmed with surgery and pathology.Results Gastric stromal tumors were mainly found in gastric fundus and body（n=16）.Ultrasonography showed most masses were well encapsulated and hypoechoic with expansive growth pattern and regular morphology.Liquefaction necrosis appeared in some lesions in which the blood flow was abundant and no lymph metastasis was found.However,gastric carcinomas were mainly found in gastric antrum（n=17）,mostly presented as ill-defined margin irregular hypoechoic lesions with invasive growth pattern and pseudokidney sign was observed because of the lesions growing around the gastric cavity.The blood flow was not abundant and lymphadenectasis was found in some lesions.The incidence of lesion distributions,morphology,internal echo and lymph metastasis was different between gastric stromal tumors and gastric carcinomas（P〈0.05）,while the color flow signals between the two groups had no statistical difference（P〉0.05）.Conclusion Transabdominal ultrasonography is an effective method to differentiate gastric stromal tumors and carcinomas.