增强螺旋CT在进展期胃癌手术方案选择及可切除性评价中的价值

Value of contrast-enhanced CT in evaluating the surgical planning and resectability of advanced gastric cancer

目的探讨多层螺旋CT(MSCT)增强扫描在进展期胃癌术式选择以及可切除性判断中的应用价值。方法回顾性分析2013年2月至2015年3月收治的198例经手术病理证实为进展期胃癌的患者资料。所有患者术前均行常规CT平扫和增强扫描,结合患者CT诊断与手术及病理结果,比较两种扫描方法对进展期胃癌可切除性评估的准确性。结果 185例行根治性切除,13例因术中发现不可切除因素行姑息性或腹腔镜探查手术。198例患者平扫、增强CT检出率分别为93.9%(186/198)、96.5%(191/198)。在手术切除范围、腹腔镜辅助及开腹选择、远处转移判断方面,平扫CT的准确性分别为87.6%(149/170)、82.3%(130/158)、63.6%(7/11),增强CT的准确性分别为93.1%(149/160)、92.9%(130/140)、72.7%(8/11),两者在腹腔镜辅助及开腹选择的差异有统计学意义(P=0.036)。平扫CT对进展期胃癌可切除判断的敏感度、特异度、准确性分别是89.2%(165/185)、23.1%(3/13)、84.8%(168/198),增强CT则分别为93.0%(172/185)、38.5%(5/13)、89.4%(177/198),两者差异有统计学意义(P<0.01)。结论 MSCT增强扫描在判断切除范围,淋巴结及远处脏器转移方面准确性较高,在手术方式选择及腹腔镜辅助和开腹手术选择方面有重要参考价值,进而提高了进展期胃癌可切除性评估的准确性。

Objective To compare the diagnostic performance of abdominal enhanced-contrast CT for the resectability of gastric cancer with conventional computed tomography （CT）. Methods The traditional CT and enhanced CT images of patients with advanced gastric cancer were analyzed and the results in assessing resectability were compared. The diagnosis of advanced gastric cancer and resectability were confirmed by intraoperative findings and histopathology. Results One hundred and eighty-five cases underwent radical resection, and the other 13 were turned to palliative or laparoscopic exploration due to unresectable factors. The detection rates of conventional and enhanced CT were 93.9% （186/198） and 96.5%（191/198）, respectively. The accuracy of conventional CT was 87.6%, 82.3%and 63.6%in the scope of surgical resection, operation choice and distant metastasis, and the accuracy of enhanced CT were 93.1%, 92.9%, 72.7%, respectively. There was a significant difference between the two groups （P=0.036）. The sensitivity, specificity and accuracy of conventional CT and enhanced CT in the resection of advanced gastric cancer were 89.2%, 23.1%, 84.8% and 93.0%, 38.5%, 89.4% respectively, with a statistically significant difference （P〈0.01）. Conclusion Abdominal contrast-enhanced CT is more accurate for the resectability of gastric cancer, minimally invasive and better resectional range than conventional plain CT.