胃癌术前超声内镜分期与转移相关基因表达的同步检测分析

目的 为了探讨超声内镜胃癌分期与转移相关基因的关系。方法 本应用超声内镜(EUS)对73例胃癌患进行术前分期，取内镜活检组织同步进行p53、nm23、c-erbB32等基因蛋白产物的检测。结果 肿瘤浸润达浆膜层后或有淋巴结转移的胃癌p53、c-erbB2及复合表达率均明显增高，nm23单独表达在胃癌各期中无明显的统计学差异。结论 提示胃癌转移相关基因表达与术前EUS分期有较好的相关性，并与浆膜层浸润及癌转移潜能密切关系，术前EUS检查尤应特别注意癌浸润是否已达浆膜层。     

胃癌术前超声内镜分期与转移相关基因表达的同步检测分析

目的为了探讨超声内镜胃癌分期与转移相关基因的关系。方法本文应用超声内镜(EUS)对73例胃癌患者进行术前分期,取内镜活检组织同步进行 p53、nm23、c-erbB2等基因蛋白产物的检测。结果肿瘤浸润达浆膜层后或有淋巴结转移的胃癌 p53、c-erbB2及复合表达率均明显增高,nm23单独表达在胃癌各期中无明显的统计学差异。结论提示胃癌转移相关基因表达与术前 EUS 分期有较好的相关性,并与浆膜层浸润及癌转移潜能密切关系,术前 EUS 检查尤应特别注意癌浸润是否已达浆膜层。     

胃癌超声内镜分期和术中分期之比较

目的：比较内镜超声（EUS）和手术时触摸法对判断胃癌浸润深度及胃周淋巴结转移的准确性。方法：73例经病理证实的胃癌病例，于术前接受EUS检查并在术时按Rhode原则进行评估，其结果与术后组织病理分期学相比较。结果：在判断胃癌浸润深度（T）上，EUS的准确性为80．8％（59／73），手术时评估的准确性为58．9％（43／73）。在判断淋巴结转移（N）上，前者的准确性为60．3％，后者为65．8％；但在26例NO病例中，EUS分期的准确性为92．3％而手术时评估的准确性仅为57．7％。结论：EUS判断胃癌的T及N0，较术中临床评估更为准确。     

内镜超声检查与多层螺旋CT对胃癌术前分期的对比研究

目的探讨内镜超声检查与多层螺旋CT在胃癌术前分期中的应用价值。方法对46例经活检证实的胃癌患者术前分别行内镜超声和多层螺旋CT检查,并与术后病理检查结果对照。结果内镜超声检查的术前T、N、M和TNM临床分期准确率分别为80.4%、68.3%、91.3%和65.1%;而多层螺旋CT分别为80.4%、80.5%、97.8%和65.1%,两者各参数间比较差异均无显著性意义。当两者相结合时则分别可提高到91.3%、85.4%、97.8%和83.7%,前3项参数准确性的提高无统计学意义,而TNM临床分期准确性的提高与内镜超声检查及多层螺旋CT的结果比较,差异有显著性意义(χ2=6.13,P<0.05)。对Ⅱ～Ⅳ期胃癌术前分期结果分析,内镜超声检查、多层螺旋CT及两者相结合的术前TNM临床分期准确率分别为50.0%、75.0%和85.7%,内镜超声检查与两者相结合的准确率之间差异有显著性意义(χ2=6.75,P<0.01)。结论内镜超声检查与多层螺旋CT对胃癌术前分期均有较高的准确性,特别是两者相结合应用,对胃癌患者治疗方案的选择和预后评价有重要的指导意义。     

内镜超声在结直肠癌术前分期中的应用价值

目的 探讨内镜超声（EUS）在结直肠癌术前TNM分期中的应用价值。方法 对60例手术切除的结直肠癌患术前行内镜超声检查,术后进行病理检查,将两对肿瘤侵犯深度的诊断结果进行比较。结果 经EUS检查,发现正常结直肠壁表现为5层结构,第1、3、5民支表现为高回声,第2、4层表现为低回声。第1、2层为黏膜层,第3层为黏膜下层,第4层为固有肌层,第5层为浆膜下和浆膜层。EUS下结直肠癌表现为低回声肿块,其回声强度介于第3层高回声和第4层低回声之间。根据EUS下结直肠壁5层结构和邻近器官的改变判断肿瘤侵犯的深度,进行TNM分期诊断。肿瘤旁直径大于或等于5mm圆形的低回声病灶诊断为转移性淋巴结。EUS对本组结直肠癌TNM分期诊断总的准确率为85．0％;周围淋巴结转移诊断的敏感性和特异性为54．8％和66．7％。结论有EUS对结直肠癌侵犯深度的判断有较高的准确率,对术前TNM分期诊断有一定价值。术前EUS检查可以结直肠癌治疗选择合适的方案提供指导。     

内镜超声对结直肠癌术前分期的评价

目的：探讨内镜超声(endoscopic ultrasonography，EUS)在结直肠癌术前TNM分期中的应用价值。方法：对81例手术切除的结直肠癌患者术前行内镜超声检查，所有病例术后均得到病理证实。结果：EUS检查发现正常结直肠壁表现为5层结构，第1，3，5层表现为高回声，第2，4层表现为低回声。第1，2层为黏膜层，第3层为黏膜下层，第4层为固有肌层，第5层为浆膜下和浆膜层。EUS下结直肠癌表现为低回声肿块，其回声强度介于第3层高回声和第4层低回声之间。根据EUS下结直肠壁5层结构和邻近器官的改变判断肿瘤侵犯的深度，进行T分期诊断。肿瘤旁直径≥5mm圆形的低回声病灶诊断为转移性淋巴结。EUS对结直肠癌T分期诊断总的准确率为82．7％，周围淋巴结转移诊断的敏感性和特异性为55．4％和68．7％。结论：EUS对结直肠癌侵犯深度的判断有较高的准确率，对术前TNM分期诊断有一定价值。术前EUS检查可以为结直肠癌选择合适的治疗方案提供指导。     

食管癌与贲门癌患者术前内镜超声检查28例分析

目的 通过对比内镜超声及CT在食管癌、贲门癌术前进行T、N分期中的准确度,评价内镜超声的临床应用价值. 方法 对28例食管癌、贲门患者术前均行内镜超声扫描和CT扫描,并分别进行T、N分期,以术后病理为金标准,比较两者分期的准确性有无差异,同时对比两者对淋巴结转移的准确率(即真实性)的差异,判断内镜超声的应用价值. 结果 本组28例病例中,T分期准确率内镜超声为89.3%(25/28),高于CT的46.4%(13/28),差异有统计学意义(P=0.004,P＜0.01).N分期中,内镜超声与CT的准确率分别为82.1%(23/28)及50.0%(14/28),差异有统计学意义(P=0.035,P＜0.05).对转移淋巴结的分组统计中,内镜超声与CT的准确率分别为88.7%及72.2%,有显著性差异(χ2=7.031,P=0.008,P＜0.01).结论 内镜超声在食管癌、贲门癌术前分期中有重要作用,其T分期准确率明显高于传统CT扫描.以淋巴结短径、S/L(淋巴结短径/淋巴结长径)并结合淋巴结的超声显像特征进行分析,提高了判断淋巴结转移以及N分期的准确性.     

超声内镜检查对食管癌术前TN分期的临床价值

目的判断超声内镜(EUS)在食管癌术前TN分期与术后病理检查的一致性。方法回顾分析286例食管癌手术患者术前EUS检查结果和术后病理资料,所有患者均经电子胃镜+活体组织病理检查确诊,将EUS分期与术后病理分期进行比较。结果 EUS T分期的灵敏度为87.76%,N分期的灵敏度为89.16%,T分期的准确率为87.76%,N分期的准确率为89.16%,T分期Kappa值为0.575,TN分期Kappa值为0.606,一致性为基本满意。N分期Kappa值为0.78,一致性为相当满意,P0.01。结论 EUS对食管癌术前T、N分期诊断准确率较高,有助于临床医生合理选择食管癌治疗方案。     

内镜活检对胃癌组织学分类术前诊断的价值

目的 探讨内镜活检对胃癌组织学分类术前诊断的价值。方法 术前对141例胃癌患的内镜活检标本分别根据Lauren分类和世界卫生组织（WHO）分类判断组织学分类，并与手术标本结果对照。结果 内镜活检对胃癌Lauren分类术前诊断的准确率为76.6%。对肠型胃癌诊断的敏感性和特异性分别为85.4%和80.6%。而对弥漫型胃癌则分别为82.7%和80.3%，在59例术前诊断为肠型胃癌的病例中，18例（30.5%)在手术标本中呈弥漫性行生长，而在75例术前诊断为弥漫型胃癌的病例中，仅6例（8.0%)术后诊断为肠型胃癌，内镜活检对胃癌WHO分类术前诊断的准确率为87.2%，其中对乳头状/管状腺癌，黏液腺癌和印戒细胞癌的敏感性分别为91.9%。33.3%和66.7%。结论 内镜活检对胃癌组织学分类的术前诊断具有较高的临床应用价值。     

胃癌术前分期诊断的研究进展

目的介绍胃癌术前分期诊断常用检查方法的研究进展。方法收集近年来国内、外胃癌术前分期诊断常用检查方法的相关文献并进行分析。结果经腹超声、超声内镜、CT、MRI、PET及腹腔镜检查为胃癌术前分期诊断提供了客观依据,提高了胃癌术前分期诊断的准确性。结论各种检查技术的不断提高,有助于临床医生更好地判定胃癌术前分期,也有助于根据不同的分期实施不同的术式。     

Role of endoscopic ultrasonography in preoperative staging of gastric carcinoma

Background: Preoperative staging of tumour extent in upper gastrointestinal malignancy greatly facilitates planning of therapy. The present study was undertaken to see whether preoperative endoscopic ultrasonography (EUS) accurately predicts the tumour stage in gastric carcinoma. Methods: Endoscopic ultrasonography was performed preoperatively on 112 patients with gastric cancer. All 112 patients underwent surgery. The results of EUS were compared with postoperative histological staging. Results: Endoscopic ultrasonography was correct in determining the primary tumour (T) and regional lymph node (N) staging in 83.0% and 64.2% of patients, respectively. EUS was correct in determining the absence of lymph node metastasis in 87.5% but was not reliable in determining metastasis in one to six regional lymph nodes (N1) and metastasis in seven to 15 regional lymph nodes (N2) stages; (61.5% and 33.3%, respectively). Of 26 patients with N1 stage, 10 had false negative results, whereas 11 patients in stage N2 were diagnosed endoscopically as stage N1. The sensitivity and specificity were 67.2% and 89%, respectively. The actual resection rate (75%) was almost identical to the rate predicted preoperatively by EUS (78%). Conclusion: Endoscopic ultrasonography staging is the most accurate method for discriminating between potentially resectable (tumour invading lamina propria or submucosa (T1) to tumour that penetrates the serosa (visceral peritoneum) without invading adjacent structures (T3)) and potentially non‐resectable (tumour invading adjacent structures (T4)) cases of upper gastrointestinal cancer.     

超声内镜在胰腺及壶腹周围占位术前评估中的临床作用

目的评估超声内镜(EUS)对胰腺及壶腹周围占位的诊断及术前TNM分期的作用。方法回顾性分析34例壶腹部占位患者术前EUS资料,并与术后病理结果比较,评估EUS术前诊断准确性。结果 EUS对胰腺占位病灶显示率92.31%,诊断准确率84.62%,T分期判断准确性为76.92%,N分期判断准确性为53.85%;对壶腹部占位病灶显示率为93.75%,诊断准确率93.75%,T分期判断准确性为62.50%,N分期判断准确性为68.75%。结论 EUS对胰腺及壶腹周围占位的诊断及术前TNM分期具有一定作用。     

Endoscopic ultrasonography and magnetic resonance in preoperative staging of rectal cancer: Comparison with histologic findings

The development of new surgical techniques and use of neoadjuvant therapy have increased the need for accurate preoperative staging of rectal cancer. We compared the ability of endoscopic ultrasonography (EUS) and two magnetic resonance imaging (MRI) coils to locally stage rectal carcinoma before surgery. Forty-nine patients with histologically proven rectal carcinoma were T and N staged by EUS and either body coil MRI or phased-array coil MRI. After radical surgery, the preoperative findings were compared with histologic findings on the surgical specimen. For T stage, accuracies were 70% for EUS, 43% for body coil MRI, and 71% for phased-array coil MRI. For N stage, accuracies were 63% for EUS, 64% for body coil MRI, and 76% for phased-array coil MRI. For T stage, EUS had the best sensitivity (80%) and the same specificity (67%) as phased-array coil MRI. For N stage, phased-array coil MRI had the best sensitivity (63%) and the same specificity (80%) as the other methods. EUS and phased-array coil MRI provided similar results for assessing T stage. No method provided satisfactory assessments of local N stage, although phased-array coil MRI was marginally better in assessing this important parameter. Although none of the results differed significantly, phased-array coil MRI seems to be the best single method for the preoperative staging of rectal cancer. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (oral presentation).     

早期胃癌行内镜黏膜下剥离术指征及评价

内镜黏膜下剥离术（ESD）是一种内镜下整块切除病变黏膜的治疗方法,已经成为早期胃癌的治疗选择之一。目前ESD治疗早期胃癌较为积极的指征为：（1）分化型黏膜内癌如果表面未形成溃疡,则病变大小不受限制;（2）分化型黏膜内癌如果表面已经形成溃疡,则病变直径≤30mm;（3）分化型sm1癌,病变直径≤30mm;（4）未分化型黏膜内癌,表面未形成溃疡,且病变直径≤20mm。尽管长期随访的资料较少,但目前看来,如果合理地把握ESD治疗指征,早期胃癌的治愈率与手术相当,但可减少并发症,提高病人生活质量,具有安全、可行、有效的特点。     

Modified devascularization surgery for isolated gastric varices assessed by endoscopic ultrasonography

Background This study aimed to assess the role of endoscopic ultrasonography (EUS) in the surgical management of isolated gastric varices (IGV), and to report the authors experience in the treatment of IGV with modified devascularization surgery.Methods In this study, 26 cirrhotic patients with IGV were treated with devascularization surgery for variceal hemorrhage. Preoperatively, percutaneous transhepatic portography (PTP) and EUS were used to determine the mode of therapy for IGV. Fundectomy was performed for 14 patients with fundic IGV, whereas 12 patients with cardiac IGV underwent proximal gastrectomy.Results A significantly higher proportion of patients with cardiac varices showed grade 3 IGV on preoperative EUS than those who had fundic varices (p < 0.05). No major complications were observed during or after the operation, and only one patient died of prolonged shock and massive transfusion. Postoperatively, gastric varices had been eradicated completely in 25 of 26 patients, as determined by EUS study. During a mean follow-up period of 50 months, two patients had recurrent varices without bleeding, as demonstrated by EUS. The overall 5-year survival rate for the fundic IGV group was 67.9%, whereas that for the cardiac IGV group was 64.3% (p > 0.05).Conclusions This study showed that devascularization surgery is highly effective for the prevention of recurrent bleeding from IGV and provides an alternative treatment method. Preoperatively, EUS is very helpful in detailed devascularization of patients with specific IGV, and may be used also for postoperative follow-up evaluation.     

超声内镜对胰腺囊性肿瘤的诊断与治疗的应用进展

随着对胰腺囊性肿瘤认识的提高及影像学诊断仪器的普及,该病的检出率显著提高。由于胰腺囊性肿瘤种类繁多,病理分级可为良性、低度恶性及恶性,而且随着肿瘤体积的增大,病理分级也会不断改变。良性病变的准确诊断对于确定手术方式或内镜治疗的监测需求,以及避免对无潜在恶性的囊肿进行不必要的手术显得尤为重要。近年来,超声内镜(EUS)在胰腺囊性肿瘤的诊断及治疗方面取得了很大进展,本文综述了超声内镜对胰腺囊性肿瘤的诊断与治疗进展。     

The clinical usefulness of preoperative CEA determination in gastric cancer

Between 1980 and 1984, preoperative serum carcinoembryonic antigen (CEA) was determined in 468 patients with gastric cancer to evaluate its clinical usefulness. The positive rate of preoperative CEA was 20.9 per cent in these 468 patients. A significantly higher CEA positive rate was obtained in those patients with liver metastasis (69.2 per cent), n_3–4 (40.0 per cent), stage IV gastric cancer (37.0 per cent) and Pap, Tub₁ histological type (26.3 per cent) (p<0.01). It is interesting that the positive rate of the 49 unresectable patients was 51.0 per cent, which was significantly higher than 17.4 per cent of the 419 resectable cases (p<0.01). CEA levels in 16 of the 39 patients with liver metastasis were more than 100 ng/ml. In contrast, serosal invasion and peritoneal metastasis were less correlated to the CEA positive rate. In the 419 resected cases, the 5 year survival rate in the higher CEA group of more than 50 ng/ml (35 cases) was 4.4 per cent, which was significantly lower than 64.0 per cent in the negative group (346 cases) (p<0.01). These results show that CEA determination in patients with gastric cancer is useful for the prediction of prognosis, as well as for a diagnostic tool to discover the presence of liver or lymph node metastasis.     

超声内镜在上消化管疾病临床应用中的初步探讨

超声内镜已广泛应用于消化系统疾病的诊断,在鉴别上消化管黏膜或黏膜下病变的、区分消化管腔内病变还是腔外压迫具有重要的诊断意义.同时,超声内镜能够比较准确地判断癌肿浸润的深度及周围淋巴结转移情况,对食管癌、胃癌的术前TNM分期、可切除性及预后的判断均有极大的价值.现将扬州大学临床医学院消化科及胃肠外科超声内镜检查上消化管病变的结果作一初步总结.