胃癌患者术前钡剂造影检查对诊断和制订手术方式的临床价值

目的探讨胄癌患者术前钡剂造影检查对诊断和制订手术方式的临床价值。方法回顾性分析229例胃癌患者的临床资料．将单纯胃镜检查及胃镜联合钡剂造影检查对肿瘤位置和大小的判断结果与手术所见进行比较。结果胃镜对贲门癌、胃体癌和胃窦癌的位置和范围判断的准确率分别为100％和78．4％、94．6％和86．5％以及98．1％和84．6％：胃镜联合钡剂造影检查判断的准确率则分别为100％和84．8％、100％和91．9％以及99．0％和90．4％：胃镜与胃镜联合钡剂造影检查对肿瘤位置和范围判断准确率的差异无统计学意义（P〉0．05）。胃镜判断贲门癌累及食管长度的准确率为60．6％．胃镜联合钡剂造影检查判断的准确率则为90．9％．两者差异具有统计学意义（P〈0．05）。胃镜联合钡餐检查较之胃镜能更准确地预测食管受累的贲门癌患者开胸手术的可能性（P〈0．05）。结论贲门癌患者术前有必要行钡剂造影检查以明确食管下端是否受累及受累长度．对选择手术入路有指导意义．而胃体癌和胃窦癌患者术前在胃镜能明确肿瘤位置和大小的情况下可不必行钡剂造影检查。

Value of preoperative barium contrast examination for the diagnosis and operative planning in gastric cancer

Objective To investigate the value of preoperative barium contrast examination for the diagnosis and operative planning in gastric cancer.Methods Clinical data of 229 gastric cancer patients were analyzed retrospectively.Lesions were divided into three parts: the cardiac,the body,and the antrum.The diagnostic accuracy of localization and the extent of tumor between gastroscopy alone and gastroscopy plus barium contrast were compared with the results of surgical findings.Results The diagnostic accuracy of localization and the extent of tumor for gastroscopy in the cardiac,the body and the antrum cancers were 100% and 78.4%,94.6% and 86.5%,98.1% and 84.6%,respectively,while for gastroscopy plus barium contrast were 100% and 84.8%,100% and 91.9%,99.0% and 90.4%,respectively.The diagnostic accuracy of both the localization and the extent of tumor were not significantly different between gastroscopy alone and gastroscopy plus barium contrast(P>0.05).Diagnostic accuracy of the length of esophagus infiltrated by cardiac cancer in gastroscopy was 60.6%,while in gastroscopy plus barium contrast was 90.9%,which was significantly different(P<0.05).Gastroscopy plus barium contrast was more accurate in predicting the possibility of thoracotomy in cardiac cancer infiltrating the lower esophagus.Conclusions It is necessary to perform preoperative barium contrast examination in cardiac cancer patients,so as to identify whether the lower esophagus is infiltrated and to measure the length of lesion,which can provide evidences for making a decision of thoracotomy.For gastric body and antrum cancer,there is no indication for barium contrast examination if gastroscopy findings are satisfied.