CAJ | 학술논문

目的评估在螺旋CT筛选出胃癌侵犯胰腺病例的基础上,联合应用超声内镜(EUS)和PET-CT检查对胃癌侵犯胰腺的术前诊断价值.方法前瞻性选取60例术前螺旋CT检查诊断为胃癌侵犯胰腺的患者,联合EUS检查(60例)和PET-CT检查(14例),判断是否存在胃癌侵犯胰腺,并与手术探查和术后病理结果进行对照.结果手术探查和术后病理结果显示,60例患者中,38例存在胰腺侵犯,22例无胰腺侵犯.CT在胃癌侵犯胰腺方面诊断的准确率为63.3%,过度诊断率为36.7%.在CT诊断的基础上,结合EUS检查诊断胃癌侵犯胰腺的准确率达到87.8%,过度诊断率为7.3%,与单纯使用螺旋CT检查相比,差异具有统计学意义(P<0.01);与PET-CT检查相比,差异无统计学意义(P>0.05).螺旋CT和EUS检查在诊断胃癌侵犯胰腺位置、侵犯胰腺程度等方面比PET-CT检查更有优势(P<0.01).结论术前应用螺旋CT诊断胃癌侵犯胰腺的准确率尚有待提高;在螺旋CT检查的基础上联合应用EUS可提高术前诊断的准确率;螺旋CT和EUS检查在诊断胃癌侵犯胰腺位置、侵犯胰腺程度等方面可提供比PET-CT更多的信息.
목적 평고재라선CT사선출위암침범이선병례적기출상,연합응용초성내경(EUS)화PET-CT검사대위암침범이선적술전진단개치.방법 전첨성선취60례술전라선CT검사진단위위암침범이선적환자,연합EUS검사(60례)화PET-CT검사(14례),판단시부존재위암침범이선,병여수술탐사화술후병리결과 진행대조.결과 수술탐사화술후병리결과 현시,60례환자중,38례존재이선침범,22례무이선침범.CT재위암침범이선방면진단적준학솔위63.3%,과도진단솔위36.7%.재CT진단적기출상,결합EUS검사진단위암침범이선적준학솔체도87.8%,과도진단솔위7.3%,여단순사용라선CT검사상비,차이구유통계학의의(P<0.01);여PET-CT검사상비,차이무통계학의의(P>0.05).라선CT화EUS검사재진단위암침범이선위치、침범이선정도등방면비PET-CT검사경유우세(P<0.01).결론 술전응용라선CT진단위암침범이선적준학솔상유대제고;재라선CT검사적기출상연합응용EUS가제고술전진단적준학솔;라선CT화EUS검사재진단위암침범이선위치、침범이선정도등방면가제공비PET-CT경다적신식.
Objective To evaluate the value of EUS and PET-CT in combination with spiral CT in preoperative assessment of gastric cancer invasion to the pancreas. Methods Sixty advanced gastric cancer patients with suspected pancreatic invasion detected by spiral CT were selected in this study. All the 60 cases were then examined by EUS and 14 of them by PET-CT. The results were compared and evaluated with the findings during surgical operation and pathological results. Results The rate of correct preoperative diagnosis of pancreatic invasion by spiral CT in advanced gastric cancer patients was 63.3%, with an overdiagnosis rate of 36.7%. The diagnostic accuracy was increased to 87.8% and overdiagnosis reduced to 7.3%, when combined with EUS. There was a significant difference in diagnostic accuracy between spirl CT alone and spiral CT combined with EUS(P <0.01), but no significant difference between spirl CT alone and spiral CT combined with PET-CT (P > 0.05). Spiral CT-EUS was more valuable in assessment of tumor location and invasion than PET-CT (P < 0.01). Conclusion The accuracy of spiral CT alone in the preoperative assessment of advanced gastric cancer with invasion to the pancreas is not high enough yet at present. Spiral CT combined with EUS can provide more accurate imformation on the tumor location, invasion site and extent of gastric cancer invasion to the pancreas, and reduce the overstaging rate caused by spiral CT alone. However, spiral CT combined with PET-CT does not show such improvement significantly.