术前内镜超声对胃癌浸润深度及手术可切除性评估的研究

胃癌是最常见的消化道恶性肿瘤之一。内镜超声检查术(endoscopic ultrasonography,EUS)对消化道管壁的高分层成像能力使其成为判断癌肿局部浸润深度的有力工具,同时,对超声范围内的周围结构的观察使得对淋巴结或邻近脏器受累情况的了解成为可能。国内外研究指出,EUS在对胃癌分期中存在分期过度(overstaging)或分期不足(understag-

术前超声内镜检查在指导胸腔镜食管癌手术选择中的应用价值

目的给予接受胸腔镜食管癌手术的患者术前超声内镜检查,并对其临床效果与具体价值进行分析、探讨。方法选取2019年3月—2021年3月枣庄市立医院接收的120例食管癌患者,将其按照诊断顺序分为常规组与观察组,各60例。常规组术前给予CT检查;观察组术前给予患者超声内镜检查。对比两组患者的基本资料与患病信息(食管癌术前分期情况、食管癌切除情况)。结果观察组患者术前分期(N0~N1期)诊断率为92.30%、66.66%,明显高于常规组(55.55%、33.33%),差异有统计学意义(P<0.05);观察组患者不同分期(N0~N1期)食管癌的切除率为89.74%、90.47%,明显高于常规组(69.44%、58.33%),差异有统计学意义(P<0.05)。结论将术前超声内镜应用于胸腔镜食管癌手术中,可提升术前对食管癌的分期诊断,预后效果显著。

Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration

AIM： to evaluate the role of endoscopic ultrasonographyguided fine needle aspiration （EUS-FNA） in the preoperative diagnosis of gastrointestinal stromal tumor （GIST）.METHODS： From September 2002 to June 2006, Fiftythree consecutive EUS-FNAs of GI tract subepithelial hypoechoic tumors with continuity to proper muscle layer suspected as GIST by standard EUS were evaluated prospectively. The reference standards for the final diagnosis were surgery （n = 31）, or clinical follow-up （n = 22）. Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared.RESULTS： In 2 cases puncture was not performed because of anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 82% （42/51）. The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 71% （15/21）, 86% （18/21）, and 100% （9/9）,respectively. In 29 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of GIST were 100%（24/24）, 80% （4/5）, 96% （24/25）, 100% （4/4）, and 97% （28/29）, respectively. No major complications were encountered.CONCLUSION： EUS-FNA with immunohistochemical analysis is a safe and accurate method in the pretherapeutic diagnosis of GIST. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for GIST.

Relationship between preoperative staging by endoscopic ultrasonography and MMP-9 expression in gastric carcinoma

AIM: To investigate the relationship between the staging by endoscopic ultrasonography (EUS) and the expression of carcinoma metastasis associated gene in the patients with gastric carcinoma. METHODS: Sixty-three patients with gastric cancer were diagnosed by electric gastroscopy and EUS. The preoperative staging of gastric cancer was measured by EUS and compared with pathologic staging and MMP-9 expression. Peripheral serum level of MMP-9 was measured with enzyme-linked immunosorbent assay (ELISA), while the expression of MMP-9 protein was tested with immunohistochemistry and hybridization in situ in the gastric carcinoma tissues. RESULTS: The total accuracy of EUS in estimating invasive depth of gastric cancer was 80.95%, while that in estimating lymphatic metastasis was 73.02%. Serum MMP-9 levels were consistent with the expression of MMP-9 protein and MMP-9 mRNA in tissue, a result closely correlated with invasive degree, staging with EUS and lymphatic metastasis in gastric cancer (P < 0.05). The total accuracy of estimating invasive depth in gastric cancer was 95.22% using both EUS and MMP-9. CONCLUSION: The MMP-9 level of preoperative serum presents the reference value for preoperative staging by EUS in the patients with gastric cancer. When serum MMP-9 level in gastric cancer is significantly high, physicians should pay closer attention to the metastasis which reaches the serosa or beyond. Combining EUS and MMP-9 improves the accuracy in deciding the invasion and metastasis in the patients with gastric carcinoma.