内镜超声检查对胃癌术前评估淋巴结状况的价值

Value of Endoscopic Ultrasonography in Preoperative Assessment of Lymph Node Status of Gastric Carcinoma.

目的 :探讨内镜超声检查 (EUS)对胃癌淋巴结状况术前评估的价值。方法 :对 12 4例经胃镜活检证实的胃癌病人术前行内镜超声检查 ,并与手术病理对照。结果 :EUS对胃癌淋巴结状况的判断准确度、淋巴结转移的敏感度和特异度分别为 82 .1%、76 .3%和 89.4 %。EUS对胃癌N分期的准确度 6 5 .1% ,其中N0 89.4 %、N1 6 4 .3%、N2 2 9.0 % ,且其对T1 T2 和T3 T4 期胃癌N分期的准确度分别为 82 .4 %和 4 9.1% ,具有统计学意义 (χ2 =10 .0 8,P <0 .0 0 1)。EUS对胃周转移淋巴结的检出率为 2 6 .4 % ,且转移淋巴结直径越大 ,其检出率也越高。同时 ,EUS对各组淋巴结转移的敏感度为37.8% ,其中对第 3组的敏感度达 71.1% ,与总体敏感度相比具统计学意义 (χ2 =16 .6 7,P <0 .0 0 1)。结论 :内镜超声检查对胃癌术前评估淋巴结状况具较高的临床应用价值。

Objective: To explore the value of endoscopic ultrasonography (EUS) in preoperative assessment of lymph node status of gastric carcinoma. Methods: EUS was performed in 124 patients with gastric carcinoma confirmed by biopsy, and the results were compared with pathological findings after the operations. Results: The accuracy rate rate of preoperative EUS in diagnosing the lymph node status of gastric carcinoma was 82.1%, and the sensitivity and specificity were 76.3%and 89.4% respectively. The accuracy rate of EUS in determining the N stage of gastric carcinoma was 65.1% (N 089.4%, N 1 64.3%, N 2 29.0 %), among which, the accuracy rate of T 1/T 2 and T 3/T 4 staging was 82.4% and 49.1% respectively(χ 2=10.08, P<0.001). The detectable rate of perigastric metastatic lymph nodes by EUS was 26.4%, and the greater the diameter of the metastatic lymph node, the higher the detectable rate. In addition, the sensitivity of lymph node metastases of each group by EUS was 37.8%, among which, the sensitivity of the third group reached 71.1% (χ 2=16.67, P<0.001). Conclusions: The clinical value of EUS in preoperative assessment of lymph node status of gastric carcinoma is relatively high.