CAJ | 학술논문

目的通过高场强MRI与X线钡餐造影、胃镜检查的对比研究,探讨MRI在胃癌术后复发诊断中的应用价值.方法收集临床拟诊胃癌术后复发患者53例,所有患者均接受MRI、X线钡餐造影、胃镜检查,以手术或穿刺活检病理结果为金标准,用卡方检验对上述检查方法进行统计分析.结果 53例胃癌术后患者经于术或穿刺活检病理证实:术后吻合口复发者30例,吻合口正常但发生周围及远处转移者10例,无复发者13例.MRI、X线钡餐造影和胃镜检查3种方法诊断胃癌术后吻合口复发的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为96.6％、86.9％、92.4％、90.6％、95.2％,70.0％、86.9％、77.3％、87.5％、68.9％,96.6％、91.3％、94.3％、93.5％、95.4％；诊断胃癌术后复发(包括胃外组织浸润、转移)的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为97.5％、76.9％、92.4％、92.8％、90.9％,52.5％、76.9％、58.4％、87.5％、34.4％,72.5％、84.6％、75.4％、93.5％、50.0％.诊断吻合口复发:MRI显著优于X线钡餐造影(x2=4.90,P＜0.05),MRI与胃镜检查结果比较,差异无统计学意义(x2=0.03,P＞0.05)；诊断胃癌术后复发(包括胃外组织浸润、转移):MRI显著优于X线钡餐造影(x2=12.46,P＜0.05)和胃镜检查(x2=5.26,P＜0.05).结论在评价胃癌术后复发(包括胃外组织浸润、转移)中,MRI优于X线钡餐造影、胃镜检查；MRI对指导临床治疗方案,提高胃癌术后生存率具有重要的临床意义.
목적 통과고장강MRI여X선패찬조영、위경검사적대비연구,탐토MRI재위암술후복발진단중적응용개치.방법 수집림상의진위암술후복발환자53례,소유환자균접수MRI、X선패찬조영、위경검사,이수술혹천자활검병리결과위금표준,용잡방검험대상술검사방법진행통계분석.결과 53례위암술후환자경우술혹천자활검병리증실:술후문합구복발자30례,문합구정상단발생주위급원처전이자10례,무복발자13례.MRI、X선패찬조영화위경검사3충방법진단위암술후문합구복발적령민도、특이도、준학솔、양성예측치、음성예측치분별위96.6％、86.9％、92.4％、90.6％、95.2％,70.0％、86.9％、77.3％、87.5％、68.9％,96.6％、91.3％、94.3％、93.5％、95.4％；진단위암술후복발(포괄위외조직침윤、전이)적령민도、특이도、준학솔、양성예측치、음성예측치분별위97.5％、76.9％、92.4％、92.8％、90.9％,52.5％、76.9％、58.4％、87.5％、34.4％,72.5％、84.6％、75.4％、93.5％、50.0％.진단문합구복발:MRI현저우우X선패찬조영(x2=4.90,P＜0.05),MRI여위경검사결과비교,차이무통계학의의(x2=0.03,P＞0.05)；진단위암술후복발(포괄위외조직침윤、전이):MRI현저우우X선패찬조영(x2=12.46,P＜0.05)화위경검사(x2=5.26,P＜0.05).결론 재평개위암술후복발(포괄위외조직침윤、전이)중,MRI우우X선패찬조영、위경검사；MRI대지도림상치료방안,제고위암술후생존솔구유중요적림상의의.
Objective To evaluate the clinical value of high-field-strength MRI in the diagnosis of recurrent gastric cancer compared with X-ray barium meal and gastroscope examinations.Methods All the 53 cases of postoperative recurrence of gastric cancer underwent MRI,X-ray barium meal and gastroscopy examinations.Using the results of surgery or biopsy as the gold standard,the differences in categorical data were analyzed with the Chi square test.Results Thirty postoperative recurrent gastric carcinoma in anastomotic stoma confirmed with pathological findings.There was ten cases with adjacent tissue infiltration and remote metastasis.Thirteen cases had no recurrent gastric carcinoma.The sensibility,specificity,accuracy,positive predictive value and negative predictive value for recurrent gastric carcinoma in anastomotic stoma for MRI,barium meal of alimentary canal and gastroscope were 96.6％,86.9％,92.4％,90.6％,95.2％; 70.0％,86.9％,77.3％,87.5％,68.9％; 96.6％,91.3％,94.3％,93.5％,95.4％ respectively.The sensibility,specificity,accuracy,positive predictive value and negative predictive value for recurrent gastric cancer (including adjacent tissue infiltration and remote metastasis) were 97.5％,76.9％,92.4％,92.8％,90.9％; 52.5％,76.9％,58.4％,87.5％,34.4％; 72.5％,84.6％,75.4％,93.5％,50.0％ respectively.There were significant differences between MRI and X-ray barium meal with respect to detect recurrent gastric carcinoma in anastomotic stoma and MRI is betterthan X-ray barium meal to detect recurrent gastriccarcinoma in anastomotic stoma (x2=4.90,P＜0.05).There were no significant differences between MRI and gastroscope with respect to detect recurrent gastric carcinoma in anastomotic stoma (x2=0.03,P＞0.05).In examination of recurrent gastric carcinoma including adjacent tissue infiltration and remote metastasis,MRI shows statistical differences with X-ray barium meal(x2=12.46,P＜0.05)and gastroscopy(x2=5.26,P＜0.05).Conclusions MRI had good diagnostic performance in identifying recurrent gastrie carcinoma,which is better than X-ray barium meal and gastroscope examinations.It plays an important role in directing clinical therapy and is helpful to improve postoperative survival rate of gastric carcinoma.