内镜超声检查与多层螺旋CT对胃癌术前分期的对比研究

Comparative study of endoscopic ultrasonography and multi slice spiral CT in the preoperative staging of gastric carcinoma

目的探讨内镜超声检查与多层螺旋CT在胃癌术前分期中的应用价值。方法对46例经活检证实的胃癌患者术前分别行内镜超声和多层螺旋CT检查,并与术后病理检查结果对照。结果内镜超声检查的术前T、N、M和TNM临床分期准确率分别为80.4%、68.3%、91.3%和65.1%;而多层螺旋CT分别为80.4%、80.5%、97.8%和65.1%,两者各参数间比较差异均无显著性意义。当两者相结合时则分别可提高到91.3%、85.4%、97.8%和83.7%,前3项参数准确性的提高无统计学意义,而TNM临床分期准确性的提高与内镜超声检查及多层螺旋CT的结果比较,差异有显著性意义(χ2=6.13,P<0.05)。对Ⅱ～Ⅳ期胃癌术前分期结果分析,内镜超声检查、多层螺旋CT及两者相结合的术前TNM临床分期准确率分别为50.0%、75.0%和85.7%,内镜超声检查与两者相结合的准确率之间差异有显著性意义(χ2=6.75,P<0.01)。结论内镜超声检查与多层螺旋CT对胃癌术前分期均有较高的准确性,特别是两者相结合应用,对胃癌患者治疗方案的选择和预后评价有重要的指导意义。

Objective To investigate the value of endoscopic ultrasonography (EUS) and multi slice spiral CT(MSCT) in the preoperative staging of gastric carcinoma.Methods Both EUS and MSCT were performed in 46 patients with gastric carcinoma proved by biopsy, and the results of EUS and MSCT were compared with surgical pathologic findings.Results The accuracy of T, N, M, and TNM clinical stage determined with EUS was 80 4%, 68 3%, 91 3% and 65 1% respectively; however 80 4%, 80 5%, 97 9% and 65 1% respectively with MSCT;no statistical difference existed between the two examinations. When both examinations were combined, the accuracy of T, N, M, and TNM clinical stage increased to 91 3%, 85 4%, 97 8%, and 83 7% respectively. No statistical difference was observed between the combined examinations and other single examination according to the previous three parameters, however according to the TNM clinical stage, there was statistical difference(χ2=6 13, P< 0 05). The analysis of the preoperative staging of Ⅱ～Ⅳ gastric cancer indicated that the accuracy of TNM clinical stage determined with EUS, MSCT and the combined examinations was 50 0%, 75 0%, and 85 7% respectively, and statistical difference existed among EUS and the combined examinations (χ2=6 75, P< 0 01). Conclusions EUS and MSCT are highly accurate in the preoperative staging of gastric carcinoma, especially when they are combined. There may be important instructive values in the selection of treatment and the assessment of prognosis in the patients with gastric carcinoma.