超声内镜联合经腹超声对胃癌术前TNM分期的诊断价值

Endoscopic ultrasonography and transabdominal ultrasonography in preoperative staging of gastric cancer

目的:探讨超声内镜联合经腹超声检查对胃癌术前TNM分期的诊断价值。方法:选取经胃镜下穿刺活检病理证实的胃癌患者134例,分别行超声内镜及经腹超声检查,观察并记录病灶浸润深度、周围淋巴结情况、周围及远处脏器转移情况,与术后病理TNM分期结果进行对照。结果:US的T分期准确率(75.37%)与EUS(76.12%)相似,但EUS的T4期诊断准确率仅为29.17%,显著低于US(79.17%)(P<0.05)。EUS和US的N期准确率分别为50.75%、69.40%,两者间差异有统计学意义(P<0.05)。US的N0、N1期诊断准确率较EUS稍低(分别为76.92%、84.61%;69.64%、71.43%),差异无统计学意义(P>0.05),US对N2、N3期诊断准确率均较EUS明显增高(分别为68.29%、34.15%;66.67%、12.50%),差异有统计学意义(P<0.05)。US在胃癌的M期诊断上较EUS具明显优势(M1检出率分别为83.33%、16.67%,P<0.05)。EUS和US对总的TNM分期准确率分别为64.18%和66.42%,而EUS联合US可提高至79.10%。结论:EUS和US均可对胃癌进行较准确的T1、T2、T3期诊断,但US对T4期的诊断准确率优于EUS,EUS诊断N0、N1分期较US准确率稍高,但差异无统计学意义,而US对N2、N3期诊断的准确率及M1的检出率均优于EUS,两者结合可明显提高胃癌术前TNM诊断的准确性。

Objective： To investigate the diagnostic value of endoscopic ultrasonography and transabdominal uhrasonography in preoperative staging of gastric cancer. Method： EUS and US were carried out in 134 patients of gastric cancer diagnosed by gastroscope and pathology. The invasion depth, range and boundary of the lesions were observed. Local lymph node metas tasis and the neighboring or remote organs metastasis were recorded. The results of EUS and US were compared with the re sults of operation and pathology. Results： The accuracy of US was similar to EUS in T staging （75.37% vs 76.12%）, but the accuracy of EUS in T4 staging was obviously lower than US （29.17% vs 79.17%）. The accuracy of US and EUS in N staging was 50.75% and 69.40%, with a statistical difference between them （P〈0.05）. US was slightly lower than EUS in No and N~ staging（76.92% vs 84.61%; 69.64% vs 71.43%）, but there was no statistical difference（P〉O.05）. The accuracy of US was obvi- ously higher than EUS in N~ and N3 staging（68.29% vs 34.15%; 66.67% vs 12.50%）, and there was a statistical difference（P〈 0.05）. US was obviously superior to EUS in MI stage. The accuracy of M1 staging by US and EUS was 83.33% and 16.67% respectively（P〈O.05）. The accuracy of EUS and US in TNM staging was 64.18% and 66.42% respectively, but the accuracy of EUS combined with US increased to 79.10%. Conclusion： EUS and US can both be used in T~, T2 and T3 staging, and the accuracy of US is obviously higher than EUS in T4 staging. The accuracy of EUS is slightly higher than US in No and N~ staging, but there is also no statistic difference. US is obviously superior to EUS in N：, N3 and M,. Therefore, EUS combining with US can obviously increase the accuracy of TNM staging for gastric cancer patients.