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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2017, Vol. 11 ›› Issue (02) : 115 -118. doi: 10.3877/cma.j.issn.1674-0793.2017.02.012

所属专题： 专题评论； 文献；

论著

胃窗超声造影与增强CT联合评估胃癌患者术前T分期的临床意义
林冬喜1,†(), 汪勇1, 柴凌1, 李红丽1, 舒星1   
  1. 1. 415300　常德，湖南省石门县人民医院超声科
  • 收稿日期:2016-07-20 出版日期:2017-04-01
  • 通信作者: 林冬喜

Clinical significance of combined oral contrast-enhanced ultrasonography and enhanced CT in prediction of T stage in gastric cancer

Dongxi Lin1,†(), Yong Wang1, Ling Chai1, Hongli Li1, Xing Shu1   

  1. 1. Department of Ultrasound, the People’s Hospital of Shimen County, Changde 415300, China
  • Received:2016-07-20 Published:2017-04-01
  • Corresponding author: Dongxi Lin
  • About author:
    Corresponding author: Lin Dongxi, Email:
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林冬喜, 汪勇, 柴凌, 李红丽, 舒星. 胃窗超声造影与增强CT联合评估胃癌患者术前T分期的临床意义[J]. 中华普通外科学文献(电子版), 2017, 11(02): 115-118.

Dongxi Lin, Yong Wang, Ling Chai, Hongli Li, Xing Shu. Clinical significance of combined oral contrast-enhanced ultrasonography and enhanced CT in prediction of T stage in gastric cancer[J]. Chinese Archives of General Surgery(Electronic Edition), 2017, 11(02): 115-118.

目的

探讨胃窗超声造影及增强CT在评估胃癌患者术前T分期中的价值。

方法

收集2014年1月至2016年4月石门县人民医院经胃镜病理确诊的胃癌患者81例，在术前1周分别接受了腹部增强CT及胃窗超声造影检查，分析两种检查方法对肿瘤T分期的评估与术后病理T分期评估的差异。

结果

81例患者中T1期肿瘤7例，T2期14例，T3期41例，T4期19例；增强CT提示T1期肿瘤8例，T2期19例，T3期39例，T4期15例，评估准确性为76.5%；胃窗超声造影检查提示T1期肿瘤8例，T2期21例，T3期39例，T4期13例，评估准确性为80.2%；两种检查方法同时评估时T1期肿瘤5例，T2期16例，T3期36例，T4期24例，评估准确性为84.0%；联合两种检查方法评估肿瘤T分期的准确性高于单一使用增强CT或超声检查（P<0.05）。胃窗超声造影检查评估的T分期与术后病理T分期的一致性高于增强CT（Kappa值：0.685 vs 0.647）。

结论

联合增强CT与胃窗超声造影检查有益于胃癌患者的术前T分期评估，为早期准确诊断胃癌提供有力证据。

关键词: 胃肿瘤, 肿瘤分期, 体层摄影术，螺旋计算机, 超声检查, 胃窗超声造影
Objective

To explore the value of enhanced CT and oral contrast-enhanced ultrasonography on preoperative T stage in gastric cancer.

Methods

From January 2014 to April 2016, eighty one gastric cancer patients diagnosed by gastroscope underwent abdominal enhanced CT and oral contrast-enhanced ultrasonography 1 week before surgery respectively, to analyze the differences between the two examination methods for evaluation of tumor T staging and postoperative pathological T staging.

Results

Of the 81 patients, stage T1 tumors were found in 7 cases, T2 in 14 cases, T3 in 41 cases, and T4 in 19 cases. Enhanced CT showed 8 cases of stage T1 tumors, 19 of T2, 39 of T3, and 15 of T4; the evaluation accuracy was 76.5%. Gastric window ultrasound contrast examination showed 8 cases of stage T1 tumors, 21 of T2, 39 of T3, and 13 of T4; the evaluation accuracy was 80.2%. The combined two methods were used to evaluate T1 stage tumors in 5 cases, T2 in 16 cases, T3 in 36 cases, and T4 in 24 cases; the evaluation accuracy was 84.0%. The accuracy of combined two methods for evaluating tumor T staging was higher than that of single enhanced CT or ultrasonography (P<0.05). The consistency of predicted T staging and postoperative pathological T staging of gastric window contrast-enhanced ultrasonography was higher than that of contrast-enhanced CT (Kappa: 0.685 vs 0.647).

Conclusion

Combined enhanced CT and oral contrast-enhanced ultrasonography is helpful to evaluate preoperative T staging of gastric cancer patients and to provide strong evidence for early accurate diagnosis of gastric cancer.

Key words: Stomach neoplasms, Neoplasm staging, Tomography, spiral computed, Ultrasonography, Oral contrast-enhanced ultrasonography
图1 胃癌患者的腹部增强CT与超声造影结果对比　A为胃窦癌腹部CT横断面；B为胃窦癌腹部CT冠状面；C、D为胃窦癌的超声造影图像
表1 影像学检查评估胃癌病理T分期的准确性
检查方法 检出患者(例) 敏感度(%) 准确性(%) 阳性预测值(%) Kappa值
增强CT
准确 62 76.5 76.5 76.5
错误 19 23.5 23.5 23.5 0.647
超声造影
准确 65 80.2 80.2 80.2
错误 16 19.8 19.8 19.8 0.685
增强CT+超声造影
准确 68 84.0 84.0 84.0
错误 13 16.0 16.0 16.0 0.759
表2 影像学与病理学检查对81例胃癌患者的T分期评估
项目 检出例数 T1 T2 T3 T4
增强CT 81 8 19 39 15
超声造影 81 8 21 39 13
手术结果 81 7 14 41 19
χ2值 2.288
P值 0.026
图2 1例37岁的女性患者两次胃镜病理均提示胃腺癌（A、B），但腹部CT并没有发现肿物存在（C）；术中也并未找到肿瘤病灶，在和患者家属说明后采取了全胃切除术（D），术后病理提示第4组淋巴结中4个淋巴结有癌细胞转移（E、F，苏木精-伊红染色，×100），腹部CT并不能发现所有的T1-T2期胃癌
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