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。     

超声检查评价食管癌、贲门癌患者腹膜后浸润的临床应用

目的:探讨评价食管癌、贲门癌患者腹膜后浸润的客观指标。方法:对18例食管癌、24例贲门癌患者进行超声检查,并与手术结果对照。结果:手术结果显示,35例显示“越峰征”的肿瘤患者术中未见腹膜后浸润发生;7例“越峰征”阴性患者,4例显示腹膜后浸润。结论:“越峰征”可以作为评价上腹部腹膜后浸润的客观指标。     

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。     

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。     

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。     

超声内镜在胃癌术前诊断中的应用分析

目的探讨超声内镜(EUS)在胃癌术前TN分期中的应用经验。方法术后病理检查证实为胃癌而且使用超声内镜进行了术前TN分期的患者352例,对其资料进行回顾性分析。结果 EUS胃癌术前T分期总正确率为81.25%,其中T1为85.58%,T2为73.91%,T3为82.14%,T4为83.33%,与术后病理结果比较具有高度一致性(Kappa系数为0.75)。EUS对胃癌术前N分期总的正确率为52.84%,其中N0为85.56%,N1为56.69%,N2为28.09%,N3为26.09%,与术后病理结果比较具有一般一致性(Kappa系数为0.33)。将病变部位分为贲门、胃底、胃体、胃窦、幽门,不同部位之间的检测正确率比较,差异无统计学意义(P0.05)。结论EUS在胃癌术前诊断中具有临床意义,其中T分期可为合理制定治疗方案提供依据,N分期准确性有待提高。     

国内内镜超声检查术的应用现状

1980年,Dimagno及Hisanaga首次报告将超声传感器安装在消化内镜的顶端开展了消化管腔内的内镜超声检查术(endoscopic ultrasonography,EUS)。时隔8年,第一台机械扇型扫描超声内镜于1988年引进我国;当前,我国共有正规的超声内镜约20余台,按我国的省份平均计算,每个省尚不足一台,说明EUS在我国的应用尚不够普及。 虽然我国超声内镜的数量尚不够多,应用EUS的历史也仅十年,但迄今为止几乎所有最先进的超声内镜设备及各种频率的细径超声探头已被逐年     

腔内超声在食管癌贲门癌病人诊治中的应用

腔内超声是将超声探头通过各种非创伤性的方法插入人体生理管腔中进行高频超声扫描，从而获得该管腔管壁各层次结构和周围邻近重要脏器的超声影像图。超声波的一个特性是超声波扫描的频率与图像分辨率成正比，而与其在组织中穿透的深度成反比。腔内超声明显地缩短了超声探...     

食管癌术前分期的现状和进展

食管癌是全球某些地区和国家较常见的肿瘤 ,估计每年有 2 0万人死于本病。我国也是食管癌高发国家之一。虽然目前对食管癌外科治疗已经取得了长足进步 ,但 5年生存率仍然较低 ,其原因是缺乏准确的术前分期 ,约 60 %的病例临床分期和病理分期差距甚远。对食管癌的术前分期主要是确定病变范围、有无远处脏器转移、淋巴结受累及周围组织局部侵犯。准确的术前分期将有助于选择合理的治疗方案 ,使早期食管癌病人接受根治性外科手术 ,而对晚期食管癌病人进行姑息性外科手术或单纯放、化疗 ,同时可对不同治疗方案的疗效进行对比观察。以往采用的上…     

52例高龄患者食管癌、贲门癌切除术

本文报告自1987年11月至1999年1月手术治疗52例70岁以上的食管癌、贲门癌的情况。其中男性40例,女性12例,年龄70岁～79岁。食管癌32例、贲门癌20例,大多数患者都合并有其他疾患。本组手术并发症包括吻合口瘘4例;乳糜胸3例和脓胸3例,并有9例在住院期间死亡。作者总结高龄食管癌患者手术前后管理的经验和教训,并对死亡的原因加以分析。     

内镜超声检查和多层螺旋CT对胃癌术前T、N分期的比较研究

目的探讨内镜超声(endoscopicultrasonography,EUS)与多层螺旋CT(multi slicespiralCT,MSCT)在胃癌术前T、N分期中的临床应用价值。方法2000年10月至2002年5月,对89例活检证实的胃癌病人术前分别行内镜超声和多层螺旋CT检查,并与手术病理结果对照。结果EUS对胃癌术前T分期的准确率为75.6%,其中T176.5%,T268.8%,T384.4%,T464.7%;MSCT分别79.3%,58.8%,62.5%,90.6%和94.1%。两者差异无统计学意义(P>0.05)。EUS对胃癌术前N分期的准确率为57.5%,其中N095.8%,N145.8%,N232.0%;MSCT分别78.1%,70.8%,75.0%和88.0%。EUS和MSCT对胃癌淋巴结转移的敏感性分别为61.2%和91.8%。EUS对N0分期的准确率显著高于MSCT(P<0.05),MSCT对N和N2分期的准确率及淋巴结转移的敏感性均显著高于EUS(P<0.05,P<0.01,P<0.01)。结论内镜超声检查与多层螺旋CT对胃癌术前TN分期均有较高的准确性。     

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。     

Assessment of adventitial involvement of esophageal carcinoma by endoscopic ultrasonography

Summary The adventitial involvement (AI) of esophageal squamous cell carcinoma in 20 patients was analyzed by endoscopic ultrasonography (EUS) and computed tomography (CT). The findings were compared with the histologic evidence of tumor invasion in the resected specimens. AI was detected as an irregularity or interruption of the third layer of the esophageal wall on ultrasound examination. The overall accuracy in the assessment of depth of tumor invasion by EUS and CT scan was 80% and 68%, respectively. EUS diagnosed AI in 17 patients and detected direct tumor invasion of either the aorta, trachea or pericardium in 7 of them. In 4 patients who had severe stenotic lesions, EUS underestimated the depth of tumor invasion when compared to the histologic findings. Overall, these results, show that EUS when combined with CT scanning is a useful means of preoperatively evaluating tumor invasion in patients with esophageal carcinoma.     

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.     

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目的 评价超声微型探头（mini-probe-sonography,MPS)对大肠癌术前分期的应用价值。方法 对50例大肠癌病人进行前瞻性的术前肠镜下MPS检查,全部病人进行手术治疗,将术前分期与术后病理结果进行对比分析。结果 MPS对肿瘤浸润程度（T）的符合率T1、T2、T3、T4分别为75％、80％、88％、67％,总符合率为84％（P＜0．01）。区域淋巴结受累程度（N）的敏感性为79％,特异性为91％,阳性预测值为92％,阴性预测值为77％,总符合率为84％（P＜0．01）。结论 MPS对大肠癌提供较为准确的术前分期,提示肿瘤浸润程度及淋巴结转移,对制定治疗方案有指导意义。     

超声内镜联合CT在胃癌术前分期中的应用

目的 探讨胃癌病人运用超声内镜(EUS)联合CT进行术前分期对判定胃癌可切除性及制定优化综合治疗方案的指导意义.方法 对2010年1月至2011年3月行手术治疗的56例胃癌病人术前行EUS和螺旋CT检查分期和术后病理检查报告分期的资料进行比较分析.结果 EUS检查对T1、T2、T4期的判定具有优势,CT检查对T3的判定...     

超声内镜和CT对食管癌术前分期的诊断价值

目的探讨超声内镜（EUS）和CT检查对食管癌术前分期的诊断价值。方法于2002年7月至2004年1月对51例食管癌手术患者行术前EUS和CT及术后病理检查，将EUS和CT分期结果和手术病理分期结果进行对照。结果（1）EUS检查T、N分期的准确率分别为82．4％（42／51）和88.0％（45／51）；CT检查T、N分期的准确率分别为52.9％（27／51）和51．0％（26／51）；EUS与CT联合检查T、N分期的准确率分别为86.3％（44／51）和90．2％（46／51）。（2）3种检查方式分期结果与病理分期结果的一致性统计结果：EUS检查T、N分期的Kappa分别为0．700（P〈0．001）和0．763（P〈0.001）；CT分别为0．275（P=0．002）和0．006（P=0.964）；EUS加CT则分别为0．769（P〈0.001）和0．801（P〈0.001）。（3）各组间差异的统计结果：EUS与CT比较，PT=0．001（X^2=10.079），PN〈0.001（X^2=16．730）；EUS加CT与EUS比较，PT=0.586（X^2=0．297），PN=0．750（X^2=0.102）。结论EUS对食管癌术前T、N分期诊断准确率较高，诊断价值优于CT；EUS与CT联合应用未能显著提高食管癌T、N分期的诊断准确率。     

Comparative study of novel endoluminal ultrasonography and conventional transurethral ultrasonography in staging of bladder cancer

BACKGROUND: Recent advances in ultrasonic techniques have improved the image quality and diagnostic accuracy for staging of bladder cancer. The aim of this study was to assess the feasibility and usefulness of endoluminal ultrasonography (ELUS) in staging of bladder cancer, and to compare them with those of conventional transurethral ultrasonography (TUUS). METHODS: From 2000 to 2002, 19 patients with bladder cancer were evaluated by ELUS and TUUS before transurethral resection or biopsy. Clinical staging using ELUS, TUUS, computed tomography (CT) and magnetic resonance imaging (MRI) was compared with the results of pathological staging. RESULTS: In 16 of 19 patients, both ELUS and TUUS were able to diagnose tumor stage. In the remaining three patients, both methods were unable to evaluate stage of tumor. In two of these patients, this inability to evaluate tumor state was caused by a difficulty in depicting the tumor base in rectangular scanning. In the remaining patient, the inability to evaluate tumor stage was caused by a difficulty in recognizing the normal muscularis because of edema around the tumor base. Both diagnostic accuracies of ELUS and TUUS were 84%, which were superior to those of CT (44%) and MRI (82%). CONCLUSIONS: Endoluminal ultrasonography and TUUS were equally useful for staging diagnosis of bladder cancer. Because the ELUS probe is very small in diameter and can be manipulated under direct vision, it is superior to the TUUS in safety and in fine visualization. However, the main limitations of ELUS include an inability to evaluate the depth of invasion of large tumors and an inability to visualize the tumor base in the position of the bladder neck.     

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).