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目的评价内镜超声检查(EUS)对胃癌患者术前诊断和分期的准确性,以指导临床治疗方案的选择。方法22例经胃镜加活检病理检查确诊(17例)和疑诊为胃癌但常规活检阴性的患者(5例),同时行EUS、腹部螺旋CT检查,疑诊者在EUS检查的同时行EUS引导下细针穿刺活检(FNAB)以明确诊断。确定肿瘤侵犯深度(T)、局部淋巴结转移(N)、周围及远处器官转移(M)等分期情况,并与手术及病理对照,以评价EUS对胃癌诊断及TNM临床分期的准确性。结果5例疑诊者行EUS引导下FNAB全部成功取得肿瘤组织,病理诊断腺癌4例,印戒细胞癌1例。1例术前EUS诊断为T1N0M0期的患者行内镜下黏膜切除术,其余患者全部行外科胃癌根治术。与手术和病理结果比较,EUS对于TNM分期诊断总的敏感性和特异性分别为T:84.9%,74.2%;N:92.1%,77.1%;M:63.4%,87.5%。螺旋CT对于胃壁是否增厚及N、M分期的敏感性和特异性分别为T:27.3%,75%;N:31.5%,100%;M:50%,100%。其中EUS对于T和N分期的敏感性较CT高(P<0.05)。结论EUS术前评价胃癌临床分期具有显著的优越性,尤其是对于肿瘤侵犯深度和局部淋巴结转移的诊断,对指导临床治疗方案的选择及术后随访具有重要的参考价值。
Objective To evaluate the accuracy of endoscopic ultrasonography (EUS) in preoperative diagnosis and staging of patients with gastric cancer, in order to guide the choice of clinical treatment options. Methods Twenty-two patients were diagnosed by gastroscope plus biopsy (17 cases) and 5 patients with suspected gastric biopsy but negative by routine biopsy. EUS and abdominal spiral CT were performed simultaneously. Fine needle biopsy (FNAB) to confirm the diagnosis. Determine the depth of tumor invasion (T), local lymph node metastasis (N), peripheral and distant organ metastasis (M) and other stages, and surgical and pathological control to assess the EUS gastric cancer diagnosis and TNM clinical staging accuracy. Results FNAB was successfully obtained from 5 suspicious individuals under the guidance of EUS. Tumor tissues were obtained in 4 of 5 patients with pathological diagnosis of adenocarcinoma and 1 of signet ring cell carcinoma. One case of preoperative EUS diagnosis of T1N0M0 patients underwent endoscopic mucosal resection, and the remaining patients underwent radical surgery for gastric cancer. Compared with the results of surgery and pathology, the overall sensitivity and specificity of EUS for TNM staging were T: 84.9%, 74.2%; N: 92.1%, 77.1%; M: 63.4%, 87.5%. The sensitivity and specificity of spiral CT for thickening of gastric wall and N, M staging were T: 27.3%, 75%; N: 31.5%, 100%; M: 50%, 100% respectively. Among them, EUS was more sensitive to T and N staging than CT (P <0.05). Conclusion Preoperative EUS evaluation of gastric cancer staging has significant advantages, especially for the diagnosis of tumor invasion depth and local lymph node metastasis, the selection of clinical treatment options and follow-up has important reference value.