【作者】 邢亚楠；

【机构】 中国医科大学附属第一医院肿瘤外科；

【摘要】 目的:正确的胃癌术前分期对选择合理的治疗方案、评价预后具有重要的指导意义,我们应用多层螺旋CT三期扫描对胃癌病例进行术前分期,并与手术和病理结果对照,评价多层螺旋CT三期扫描的临床应用价值。方法:收集2004 年10月至2005年12月经胃镜取病理证实的胃癌病例,共74 例。其中,男51例,女23例,平均年龄59．6岁(31-78岁)。每位患者在术前1周均行多层螺旋CT三期扫描检查,其中, 64例行根治性切除术,6例行姑息性切除术,1例行单纯胃肠吻合术,3例行剖腹探查术。患者均有完整的手术病理资料。我们采用国际胃癌协会通用的TNM标准结合日本胃癌规约, 把CT图像结果与手术、病理结果相对照,评价MSCT三期扫描对胃癌术前T、N、M分期的准确性。结果:在74例胃癌患者中,有20例的正常胃壁显示单层结构,54例显示多层结构,其中有28例表现为双层结构,26例为三层结构。在显示多层结构的病例中,有20例(37％)在动脉期显示最清楚, 有23例(43％)在门脉期显示最清楚,但是在平衡期,所有病例的多层结构变得模糊不易分辨。整个病灶完全显示的时相因人、因病灶而异,但是,所有早期胃癌均在动脉期或门脉期明显强化,在平衡期则变得模糊。对于进行期胃癌,在动脉期通常可以看到病灶内层明显强化,在门脉期和平衡期,强化区域逐渐扩大直至病灶完全强化,但与正常胃壁差异逐渐变小。MSCT结合三维重建对进展期胃癌大体类型的判断准确率为93．85％,鉴别BorrmannⅡ和BorrmannⅢ型胃癌的准确率为94．83％(55／58)。MSCT三期扫描结合三维重建对胃癌病变的检出率为95．59％,其中对早期胃癌为66．67％, 对进行期胃癌为100％。MSCT三期扫描对胃癌术前临床 TNM分期的准确性为68．92％,鉴别I a和I b期的准确率为 88．24％(15／17),鉴别Ⅲa和Ⅲb期的准确率为69．44％(25／ 36)。其中T分期的准确性为77．03％(57／74),鉴别T2和 T3(即浆膜是否受侵犯)的准确率为82%(41／50);N分期的准确性为65．71％(46／70),其中对第二站淋巴结判断准确性要优于第一站;MSCT对胃癌远处转移判断的准确率为97． 30％,其中对肝转移判断准确率为100％,其敏感性、特异性分别为100％和98．61％,对腹膜转移判断的准确率为97．30％, 其敏感性、特异性分别为50％和100％。结论:1．MSCT三期扫描有利于胃壁层次的显示,有利于区分血管和淋巴结,可以明显提高胃癌术前分期的准确性;2．动脉期、门脉期、平衡期三期扫描各有侧重,更符合客观规律,可以动态观察,比较分析,对于指导手术、评价预后具有较高的临床应用价值。更多还原

【Abstract】 Objective: Preoperative stages play important role in therapy planning of gastric cancer, especially early-stage and stage IV gastric cancer. However, ambiguity still existed in understanding the relationship between radiologic and pathologic results, attributing to the poor quality of conventional CT image. The purpose of this study is to evaluate the value of triphasic MSCT in preoperative stage of gastric cancer. Methods: 74 MSCT images were prospectively reviewed and pathologic records were retrospectively drawn. Of all the patients, 64 underwent radical gastrectomy, 6 underwent palliative gastrectomy, 1 underwent an open biopsy. We compared the MSCT images results with pathologic and operative results, in order to evaluate the accuracy of preoperative stage. Results: The layered pattern of the normal gastric wall was clearly demonstrated in the arterial-dominant or parenchymal phase. All 6 early gastric cancers detected were most clearly depicted in the arterial-dominant or parenchymal phase. The accuracy of MSCT for tumor detection and T staging was 95.59 % and 77.03% ,respectively. The accuracy of N, M and TNM staging was 65.71%, 100% and 68.92% respectively. Conclusion: Triphasic MSCT shows good accuracy of reoperative staging, due to its better layered pattern demonstration and comparision between lymph node and vessel. MSCT wth tiphasic scan technique is more rational and could improve the accuracy of preoperative staging of gastric cancer.更多还原