超声内镜对126例胃癌术前TNM分期的临床分析

Clinical analysis of endoscopic ultrasonography in preoperative TNM staging of 126 gastric cancer cases

目的评价超声内镜（EUS）对胃癌患者术前TNM分期的准确性。方法126例行外科手术治疗的胃癌患者，于术前1周行EUS和腹部螺旋CT检查，确定肿瘤浸润深度（T）、淋巴结转移（N）、远处转移（M）等分期情况，并与术后病理TNM分期进行对照，以评价EUS对TNM分期的准确性。数据处理采用配对χ2检验。结果与术后病理结果比较，EUS对胃癌T1、T2、T3、T4分期的准确率分别为84．6％、14／18、82．0％、85．7％；EUS对胃癌N0、N1、N2、N3分期的准确率分别为74．2％、75．0％、57．9％、5／17。螺旋CT对胃癌NO、N1、N2、N3分期的准确率分别为80．6％、75．o％、73．7％、12／17。EUS与螺旋CT对NO和N1分期判断的准确率接近，而对N2和N3分期的判断，螺旋CT较EUS有明显优势（χ2=4．89，P=0．027；χ2=13．88，P〈0．01）。对于胃癌远处转移M1分期的比较，EUS与螺旋CT的准确率分别为36．4％、95．5％，螺旋CT对M1的判断优于EUS（χ2=7．90，P=0．001）。结论EUS对胃癌术前T分期具有较高的临床应用价值，而对淋巴结转移的N2、N3分期及远处转移的M分期的准确性有待提高。为获得较准确的术前TNM分期以指导治疗方案的选择，有必要联合螺旋CT检查。

Objective To evaluate the preoperative TNM staging of gastric cancer. accuracy of endoscopic ultrasonography （EUS） in Methods EUS and abdominal helical computed tomography （HCT） were performed one week before the surgery in 126 gastric cancer patients who would receive surgery to determine the depth of tumor invasion （T）, lymph node metastasis （N） and distant metastasis （M） stage and which were also compared with pathologic TNM stage after surgery to evaluate the accuracy of EUS in TNM staging. Pairing χ2 test was performed for data analysis. Results Compared with pathologic TNM stage after surgery, the accuracy of EUS in T1, T2, T3 and T4 staging of gastric cancer were 84.6%, 14/18, 82.0% and 85.7% respectively. The accuracy of EUSin N0, N1, N2 and N3 staging of gastric cancer were 74. 2%, 75. 0%, 57. 9% and 5/17 respectively. The accuracy of HCT in N0, N1, N2 and N3 staging of gastric cancer were 80. 6%, 75.0%, 73.7% and 12/17 respectively. The accuracy of EUS was similar to HCT in NO and N1 stage. For N2 and N3 stage, HCT was obviously better than EUS （χ2 =4.89, P=0. 027; χ2= 13.88, P〈 0.01）. The accuracy of EUS and HCT in M1 stage of gastric cancer were 36. 4% and 95.5% respectively, H CT was better than EUS in M1 determination （χ2=7.90, P= 0. 001）. ConclusionsThe clinical application value of EUS in the preoperative gastric cancer T staging was high, however the accuracy in determining lymph node metastasis N2 and N3 staging and distant metastasis M staging should be improved. In order to acquire more accurate preoperative TNM stage to guide the treatment selection, the combination with HCT examination is necessary.