术前判断胃癌生长方式的方法及其临床意义

Methods and the clinical significance of preoperative estimation of expansive types of gastric cancer

目的 :探讨临床常用的各种诊断方法判断胃癌生长方式的准确性及其临床意义。 方法 :以内镜、钡餐、CT观察胃癌的生长方式 ,按Borrmann分型进行分类 ,将结果与术后标本相对比 ,从而得出准确率。 结果 :内镜对判断较小的胃癌准确性高 ,较大的胃癌准确性低 ;CT对整体特征比较明显的Ⅰ、Ⅳ型胃癌判断准确性较高 ,而对需从溃疡的形态等局部特点进行鉴别的Ⅱ、Ⅲ型胃癌判断准确性较低 ;钡餐可从瘤体的边缘、溃疡的特点、整体轮廓等进行观察 ,但对肿瘤的细微变化难以观察。必须将内镜、钡餐、CT等各种方法的特点综合判断才能提高术前胃癌生长方式诊断的准确性 ;将反映胃癌“质”的特点的生物学特性的诊断与反映胃癌“量”的指标 (进展程度的诊断 )相结合 ,才能完整地评价其临床病理过程 ,作出治疗决策。 结论 :掌握并提高术前对胃癌生长方式的判断准确性 ,是采取相应。

Objectives: The research is designed to study the accuracy and characteristics of diagnostic methods for estimating the expansive type of gastric cancer in normal clinical practice, and to evaluate the clinical significance of this estimation. Methods: Preoperative Borrmann classifications of gastric cancer were diagnosed by endoscopies, barium studies and computed tomographies. The results were compared with Borrmann classifications from surgical specimens. Results:The diagnostic accuracy of endoscopy in small gastric cancers was better than that in large gastric cancers. The diagnostic accuracy of CT for type Ⅰ and Ⅳ, which have more obvious gross characteristics, was better, and for type Ⅱ and type Ⅲ, which need to be differentiated by local characteristics such as morphologic appearances of ulcers, was worse. The barium study estimated the expansive type of gastric cancer according to borders of tumors, characteristics of ulcers and whole figure, However, it was difficult to observe detailed changes. Conclusions: To improve the veracity of preoperative diagnosis for the expansive type of gastric cancer requires integrative use of endoscopies, barium studies and computed tomographies. The diagnosis of biological characteristics of gastric cancer reflects its quality, and the diagnosis of aggressive degree reflects its quantity. Only with the diagnosis of these two aspects, can we estimate the clinical pathological process of the gastric cancer completely and comprehensively, so as to select the most reasonable and desirable treatment.