【摘要】 目的探讨超声双重造影(DCUS)在进展期胃癌诊断及新辅助化疗(NAC)疗效预测中的应用价值。方法回顾性分析我院收治的74例胃癌患者的临床资料,根据癌组织是否浸润至黏膜下层将其分为早期胃癌患者30例和进展期胃癌患者44例,术前均行DCUS,并与病理结果进行比较,分析DCUS对进展期胃癌的诊断效能。早期胃癌患者行胃癌根治术,进展期胃癌患者行NAC治疗+胃癌根治术,采用实体瘤疗效评价标准评估NAC 3个周期后的疗效,将进展期胃癌患者分为有效组28例和无效组16例,比较两组NAC前及NAC 3个周期后造影剂达峰时间(TTP)、峰值强度(PI)、始增时间(RT)及病理组织微血管密度(MVD)的差异。绘制受试者工作特征曲线分析NAC后PI、MVD及其联合预测NAC疗效的价值。结果 DCUS检出48例进展期胃癌患者和26例早期胃癌患者,其诊断敏感性、特异性、准确率分别为77.27%、53.33%、67.57%。进展期胃癌患者NAC后RT、TTP水平均高于NAC前,PI水平低于NAC前,差异均有统计学意义(均P<0.05)。NAC后,有效组与无效组RT、TTP水平比较差异均无统计学意义,有效组PI和MVD均低于无效组,差异均有统计学意义(均P<0.05)。PI、MVD对进展期胃癌患者NAC疗效预测的曲线下面积分别为0.786和0.835,两者联合检测的AUC为0.839,预测价值更高(P<0.001)。结论 DCUS可用于进展期胃癌的诊断及NAC疗效的评估,具有较好临床应用价值。更多还原

【Abstract】 Objective To explore the application value of double contrast-enhanced ultrasound(DCUS)in the diagnosisof advanced gastric cancer and the prediction of therapeutic effect of neoadjuvant chemotherapy(NAC).Methods The clinicaldata of 74 cases of gastric cancer treated in our hospital were retrospectively analyzed.According to whether the cancer tissueinfiltrated into the submucosa,they were divided into 30 cases of early gastric cancer and 44 cases of advanced gastric cancer.DCUS was perfomed before the treatment,and the results was compared with patholog,the diagnostic efficacy of DCUS foradvanced gastric cancer was analyzed.Patients with early gastric cancer were treated with radical gastrectomy,and patients withadvanced gastric cancer were treated with radical gastrectomy and NAC. The therapeutic effect of three cycles of NAC wasevaluated by response evaluation criteria in solid tumors.Patients with advanced gastric cancer were divided into two groups:theeffective group(28 cases)and the ineffective group(16 cases).The time to peak(TTP),peak intensity(PI),initial increase time(RT)and pathological microvessel density(MVD)were compared between the two groups before and after NAC.The receiveroperating characteristic(ROC)curve was used to analyze the predictive value of PI and MVD after NAC.Results Forty-eightpatients with advanced gastric cancer and 26 patients with early gastric cancer were detected by DCUS. The diagnosticsensitivity,specificity and accuracy were 77.27%,53.33%,and 67.57%,respectively.In the advanced gastric cancer patients,the RT and TTP after NAC were higher than those before NAC,and the PI was lower than that before NAC.The differences werestatistically significant(all P<0.05).After NAC,there were no statistically significant difference in RT and TTP between theeffective group and the ineffective group.The PI and MVD of the effective group were lower than those of the ineffective group,and the difference were statistically significant(both P<0.05).The area under curve of PI and MVD for predicting NAC curativeeffect in patients with advanced gastric cancer were 0.786 and 0.835,respectively,and that of the two combined detection was0.839,which had higher predictive value(P<0.001).Conclusion DCUS can be used for diagnosis of advanced gastric cancerand evaluation of NAC efficacy,which has higher clinical application value.更多还原