多排CT对胃癌术前分期的单中心大宗病例研究

Value of multidetector-row CT in the preoperative staging of gastric cancer:a single-center and large-sample study

目的：探讨多排CT（multidetector-rowCT，MDCT）对胃癌术前分期的价值。方法：对1311例胃癌病人术前行MDCT检查，并与手术病理结果相对照。结果：MDCT检查对胃癌T分期的判断准确率为75．3％．其中T1期为74-3％，T2-3期为42．9％，T4a期为85．6％，T4b期为81．9％。MDCT检查判断胃癌淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为83．3％、71_8％、81．2％、74．6％和78．6％；对胃癌远处转移的判断分别为70．4％、98_3％、86．9％、95．5％和94．5％；对胃癌肝脏转移的判断分别为74．1％、99．7％、83．3％、99．5％和99．2％：对胃癌腹膜转移的判断分别为54．5％、99.3％、87．1％、96．4％和96．0％；对胃癌远处淋巴结转移的判断分别为76.3％、99．1％、84．1％、98．6％和97．8％。结论：MDCT检查对胃癌术前分期具有较高的临床应用价值．但对胃癌腹膜转移的灵敏度相对偏低．对于腹膜转移概率较大的病人仍需行诊断性腹腔镜检查．以避免不必要的剖腹探查。

Objective To investigate the value of multidetector-row CT （MDCT） in the preoperative staging of gastric cancer. Methods One thousand one hundred and thirty-one patients with gastric cancer underwent preoperative MDCT examination. The results of MDCT were compared with both surgical and pathological findings. Results The overall accuracy of MDCT in determining the T stage of gastric cancer was 75.3%, with T1 74.3%, T2-3 42.9 %, T4a 85.6%, and T4b 81.9% respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT for determining lymph node metastasis were 83.3%, 71.8%, 81.2%, 74.6% and 78.6%, respectively, and 70.4%, 98.3%, 86.9%, 95.5%, 94.5% for distant metastasis, 74.1%, 99.7%, 83.3%, 99.5% and 99.2% for determining liver metastasis, 54.5%, 99.3%, 87.1%, 96.4% and 96.0% for determining peritoneal metastasis, 76.3%, 99.1%, 84.1%, 98.6% and 97.8% for determining distant lymph node metastasis, respectively. Conclusions There is higher value of application with MDCT in the preoperative staging of gastric cancer. Diagnostic laparoscopy is needed in selected patients at high risk for peritoneal metastasis to avoid unnecessary laparotomy because of less sensitivity of MDCT for peritoneal metastasis.