增强CT对进展期胃癌术前的评估价值

目的探讨增强CT在术前评估进展期胃癌TNM分期、切除范围及手术方式中的价值。 方法回顾性分析2014年3月至2015年5月收治的150例进展期胃癌患者的资料，均经手术病理证实。所有患者术前均行上腹部增强CT检查，据此评估肿瘤的TNM分期，决策手术方式及切除范围，以手术及病理结果为标准判断增强CT分期的准确度。 结果在CT评估TNM分期方面，T分期准确度分别为：T2期84.0%（126/150），T3期76.7%（115/150），T4期92.7%（139/150）；N分期脾门、脾血管及腹主动脉旁区淋巴结判断的准确度较高（96.3%、97.0%、94.8%），胃小弯侧淋巴结有较高的敏感度（87.0%）和特异度（96.6%）；M分期总体准确度和敏感度分别为87.3%（131/150）、93.3%（126/135）。在CT评估切除范围方面，对近端、远端次全切及全胃切除术预测的准确度分别为87.9%（29/33）、88.6%（62/70），72.7%（32/44）。在评估手术方式方面，腹腔镜辅助与开腹的准确度分别为87.7%（100/114）、85.7%（30/35）。 结论增强CT在判断淋巴结转移及远处脏器转移方面有较高的准确度，在决策术式及切除范围方面有重要的参考价值，应作为进展期胃癌术前的一项常规检查。

Value of enhanced-contrast spiral CT in preoperative evaluation of advanced gastric cancer

ObjectiveTo evaluate the clinical value of preoperative abdominal enhanced-contrast spiral CT for advanced gastric cancer in TNM staging, excision range and surgery choices. MethodsOne hundred and fifty cases of advanced gastric cancer diagnosed by pathology between March 2014 and May 2015 were given enhanced-contrast spiral CT to find out the accuracy of determining TNM staging, excision range and surgical methods according to surgical and pathological findings. ResultsThe accuracy of enhanced-contrast spiral CT for staging advanced gastric cancer was relatively high, 84.0% (126/150) for T2, 76.7% (115/150) for T3, 92.7% (139/150) for T4; lymph node in hilus liens, splenic artery and paraaortic was 96.3%, 97.0%, 94.8%, respectively; the accuracy and sensitivity for predicting distant metastases was 87.3% (131/150) and 93.3% (126/135). When excision range and surgery choices were taken into consideration, the accuracy of enhanced-contrast spiral CT for proximal subtotal gastrectomy, distal subtotal gastrectomy and total gastrectomy was 87.9% (29/33), 88.6% (62/70), and 72.7% (32/44); for laparoscope assisted- and open surgery was 87.7% (100/114) and 85.7% (30/35), respectively. ConclusionEnhanced-contrast spiral CT is useful for TNM staging of gastric cancer and predicting excision range and surgical methods.