内镜超声检查对壶腹癌诊断价值的探讨

目的:探讨内镜超声检查(EUS)对壶腹癌的诊断价值.方法:对连续收治的26例壶腹癌全部实施内镜超声检查,并与US、HCT、MRI检查结果进行比较.结果:对照手术及病理结果,EUS对壶腹部肿瘤直接征象显示率达100%(26/26),而US、HCT、MRI分别为46.15%(12/26)、73.08%(19/26)和50.00%(13/26),EUS与US、HCT、MRI相比有显著差异(P=0.0045,P＜0.0001,P＜0.0001).结论:EUS是诊断壶腹癌的良好手段,在显示病变的直接征象具有明显优势.     

消化道神经内分泌癌早期诊断和治疗的探讨

目的探讨消化道神经内分泌癌临床及病理学的特征，寻求早期诊断和治疗的方法。方法将病例分为早期癌和非早期癌两组。综合分析消化道神经内分泌癌的临床资料及病理学、生物学特征，并应用统计学的方法进行比较研究。结果消化道神经内分泌癌以食管、胃和直肠多见；早期癌的大体观多为轻微隆起型，非早期癌可出现BormannⅠ型、Ⅱ型、Ⅰ型＋Ⅱ型，而Ⅲ型、Ⅳ型较为少见。结论这些特征有助于消化道神经内分泌癌的早期诊断。早期癌中≤5mm的微肿瘤可作为内镜下切除的适应证。     

内镜超声在消化道肿瘤介入诊治中的进展

随着超声内镜及其器械设备的不断发展,内镜超声技术已从起初单纯的疾病诊断步入到介入性治疗的时代,目前已经成为消化道肿瘤诊治过程中不可或缺的技术.全文对内镜超声在消化道肿瘤介入诊治中的新进展进行综述.     

乳腺常规超声与超声造影对早期乳腺癌的诊断价值

目的探讨乳腺常规超声与超声造影对早期乳腺癌的诊断价值。方法选取2016年5月至2019年5月间西安交通大学第二附属医院收治的80例早期乳腺癌患者进行回顾性研究,所有患者分别进行常规超声检查和超声造影检查。分析良恶性乳腺肿瘤的特征,并与穿刺或术后病理结果进行比较,分析两种检测方法的诊断价值。结果超声造影结果提示,乳腺恶性肿瘤主要为不均匀增强及周边增强,乳腺良性肿瘤主要为无增强和均匀增强为主。33例患者经常规超声诊断,良性16例,恶性17例,其中误诊10例(4例误诊为良性,6例误诊为恶性); 47例患者经超声造影诊断,良性12例,恶性35例,其中误诊5例(良性误诊2例、恶性误诊3例)。常规超声诊断良恶性乳腺疾病的敏感性、特异性、阳性预测值和阴性预测值分别为64. 7%、75. 0%、73. 3%和66. 7%。超声造影诊断良恶性乳腺疾病的敏感性、特异性、阳性预测值和阴性预测值分别为94. 1%、76. 9%、91. 4%和83. 3%。超声造影的敏感度明显高于常规造影,差异有统计学意义(P <0. 05)。结论常规超声联合超声造影可提高早期乳腺癌的诊断敏感度,在早期乳腺癌的诊断以及良恶性肿瘤的鉴别诊断中有重要的临床应用价值。     

消化道类癌内镜诊治34例临床分析

目的探讨消化道类癌经内镜诊治和手术治疗的适应证。方法结合文献分析消化道类癌的临床表现、内镜下特点及治疗方法。结果34例消化道类癌经内镜确诊,其中食管癌2例,胃类癌8例,十二指肠球部类癌1例,结肠类癌23例(直肠20例,乙状结肠3例)。采用内镜下电灼切除23例,局部切除2例,9例行根治手术。2例术中发现已广泛转移。结论消化道类癌直径≤1 cm应采用内镜下电灼切除,直径在1.1~2 cm可采用EMR黏膜下切除,直径>2.1 cm应采用根治性手术。     

高频超声内镜在食管癌高发区早期癌及癌前病变诊治中的价值

  目的  探讨超声内镜在食管癌高发区早期癌及癌前病变诊断及治疗中的价值。  方法  回顾分析2008年6月至2010年6月在食管癌高发区涉县、磁县进行普查发现的118例早期食管癌及癌前病变患者, 所有病例均行超声内镜(endoscopic ultrasonography, EUS)检查, 符合镜下治疗标准的内镜辅以碘染色并行内镜下黏膜切除术(endoscopic mucoscal resection, EMR), 余手术治疗。对所有行EMR术及手术治疗的患者术前EUS及术后病理结果进行对照分析。  结果  EUS判断食管早期癌及癌前病变影像学结果显示: 黏膜层癌97例、黏膜下层癌21例, EUS与病理检查结果对照判断浸润深度, 结果相符者103例, 准确率87%, 其中对黏膜层癌判断的准确率90%, 对黏膜下层癌判断的准确率76%。  结论  EUS准确评估病灶内镜可切除性, 使得内镜下黏膜切除手术更为安全有效, 对指导高发区早期食管癌和癌前病变内镜下治疗具有重要价值。      

82例食管早期表浅癌微探头内镜超声检查结果分析

为了提高食管癌的治疗效果，早期诊断至关重要，随着纤维胃镜、电子胃镜及超声内镜的应用，大大提高了早期食管癌的诊断率，为制定正确的治疗方案提供了可靠的依据。我院在1997年11月食管癌高发区开展普查，对电子胃镜、内镜超声检查(endoscopic ultrasonograpy，EUS)的82例早期食管     

内镜诊断早期食管癌7例

１９８０年来在纤维胃镜下发现早期食管癌７例，现报告如下。临床资料男５例，女２例，年龄４３～６６岁，进食觉胸骨后隐痛不适感３例，胃部不适４例。病变位于食管中段５例，位于下段２例。病理类型：糜烂性４例，斑块型２例，乳头型１例。病变分布长度２ｃｍ～４ｃｍ。...     

纵轴超声内镜对进展期胃癌的诊断价值

 目的 评价纵轴超声内镜在进展期胃癌诊断中的应用价值. 方法 29例进展期胃癌病例接受电子内镜检查与组织活检病理检查、超声内镜检查及超声内镜下穿刺细胞病理学检查,检查结果与外科手术所见及组织病理学检查结果进行比较. 结果 胃镜检查对Borrmann Ⅰ、Ⅱ、Ⅲ、Ⅳ型胃癌的确诊率分别为100%、86.4%、80%和0,而超声内镜加超声内镜介导下细胞病理学检查对4型胃癌的诊断准确率均为100%.对胃癌的TNM分期与术后病理分期的符合率为83.75%. 结论 超声内镜对进展期胃癌尤其是Borrmann Ⅳ型胃癌的诊断价值优于胃镜检查.     

早期贲门癌及癌前病变的内镜微创治疗研究

目的: 内镜微创治疗早期贲门癌及癌前病变,探讨治疗价值。 方法: 应用内镜黏膜切除(Endoscopic mu-cosal resection,EMR)和氩离子凝固(Argon plasma coagulation,APC)方法治疗高发区门诊及内镜筛检出的早期贲门癌及癌前病变104例108个病灶,统计分析病变位点分布、适应证、并发症及随访情况。 结果: 1)74.1%的病灶位于贲门12点至3点位,25.9%的病灶位于其他点位,差异有统计学意义(P<0.01)。2)EMR治疗前后病理:有4个病灶为中度不典增生、术后1个病灶被诊断为黏膜内癌;有36个病灶重度不典型增生,其中术后有3个病灶被诊为黏膜内癌,1个病灶被诊为早期浸润癌;10个病灶黏膜内癌,术后1个灶诊为早期浸润癌。3)EMR组治疗成功率96%,2个灶术后诊为早期浸润癌追加手术。4)APC组早期贲门癌治疗成功率为83.3%,癌前病变治疗成功率为100%。5)EMR组合并出血发生率为4.0%;APC组出血发生率1.7%,无其他并发症。6)EMR组随访3年生存率为100%,5年生存率为92.3%;APC组5年生存率为100%。 结论: 1)早期贲门癌及癌前病变存在高发部位,对该部位精细观察和活检,有望提高贲门病变检出率。2)将随诊6个月以上内镜及病理诊断无好转的中度不典型增生纳入治疗范围,可有效避免治疗不足。3)黏膜下注药是减少内镜治疗并发症的重要措施。4)EMR和/或APC治疗方法简便易行、安全有效、易于推广。     

内镜窄带成像技术对早期胃癌及癌前病变的诊断价值

目的：探讨内镜窄带成像技术对早期胃癌及癌前病变的诊断价值。方法选择出现反复上消化道症状病史3年以上的患者共192例,采用窄带成像联合放大内镜对胃黏膜有可疑病变的区域进行靛胭脂染色并放大观察,分别在病变活动区域取活检标本行病理组织学检查并对其结果进行比较分析。结果内镜窄带成像技术比普通胃镜图像清晰,结果有统计学差异（P＜0．01）,尤其是对于局灶性浅表性病变和胃小凹的观察,内镜窄带成像技术具有明显的优势,而在胃黏膜微血管的观察中,内镜窄带成像技术具有绝对的优势。192例患者中有7例是早期胃癌患者,4例患者是重度异型增生,9例患者为中度异型增生,有18例患者是轻度异型增生。结论内镜窄带成像技术结合放大技术能够清晰的发现早期胃癌、癌前病变,能够提高活检病理检查的阳性率,对胃癌的早期发现、早期诊断、及时治疗具有重要的临床意义。     

阴道超声在早期宫颈癌及癌前病变诊断中的临床价值研究

目的：探讨阴道超声对早期宫颈癌及癌前病变的诊断价值。方法以43例宫颈癌患者作为研究对象,其中早期宫颈癌27例,癌前病变16例。所有患者均于术前确诊并行手术治疗。另选取体检无妇科病史的30例妇女作为对照组,对三组的阴道超声声像特征进行对比分析。结果阴道超声诊断为宫颈癌前病变者16例,准确率为81．3％;超声诊断为早期宫颈癌者25例,诊断准确率为92．6％。三组的宫颈厚径与宫颈内膜厚度比较存在显著性差异（ P＜0．05）,三组间关系为：正常对照组＜癌前病变组＜早期宫颈癌组。正常对照组中均未见宫颈线中断与宫颈内出现强回声或低回声团,15例测到丰富血流;癌前病变组宫颈线中断2例,3例可见宫颈内出现强回声或低回声团,血流丰富8例;早期宫颈癌组中宫颈线中断10例,宫颈内出现强回声或低回声团8例,血流丰富22例;三组间存在显著性差异（ P＜0．05）。3组PSV与RI比较存在显著性差异（P＜0．05）;PSV：正常对照组＜病前病变组＜早期宫颈癌组;RI：正常对照组＞病前病变组＞早期宫颈癌组。结论阴道超声对早期宫颈癌及癌前病变具有较高的敏感度,可为临床提供有价值的信息,可作为细胞学检查与妇科检查的有效补充,减少漏诊或误诊病例的发生。     

Diagnostic Utility of Endoscopic Ultrasonography for Preoperative Rectal Cancer Staging Estimation

The preoperative staging accuracy of endoscopic ultrasonography(EUS) was assessed in 38 rectal cancer patients who underwentrectal EUS and curative surgery from July 1992 to September1994. We used a GF-UM20 instrument with both 12- and 7.5-MHztransducers. Compared with the histological findings, the diagnosticaccuracy rate for EUS was 76% (29/38) for the invasion depthand 85% (sensitivity) and 72% (specificity) for level one lymphnode metastasis, resulting in an overall preoperative stagingaccuracy of 74% (28/38). The diagnostic accuracy of invasiondepth was poor (only 45%: 5/11) in cases shown histologicallyto be a1 (tumor invasion through muscularis propria into parietalfat), but ranged from 90 to 100% when the a1 cases were excluded.The diagnostic accuracy for level one lymph node metastasiswas proportional to the nodal size. The size of lymph nodesthat had been diagnosed as metastatic and non-metastatic (P> 0.05) differed significantly. Eighteen (86%) of the 21metastatic nodes with histologically massive invasion were detectedpreoperatively by EUS. Eight of the 11 undetected metastaticnodes were either less than 4 mm in diameter or showed onlyslight invasion. Most (81%) of the level one metastatic nodeslarger than 5 mm were found. The worst preoperative stagingdiagnostic accuracy was for stage II cases (63%: 5/8), and infour of the 10 misdiagnosed cases, the stage was understimateddue to slight nodal invasion or skip metastasis (2 cases each).Although it was difficult to diagnose nodal metastasis correctlyin these cases, preoperative staging using EUS was considereduseful for diagnosing almost 80% of our rectal cancer cases.     

128层螺旋CT在早期周围型小肺癌诊断中的应用价值分析

目的 探讨128层螺旋CT在早期周围型小肺癌诊断中的应用价值.方法 选取疑似早期周围型小肺癌患者86例,均采用128层螺旋CT诊断.结果 疑似早期周围型小肺癌患者86例,确诊阳性75例,阴性11例,采用128层螺旋CT诊断出真阳性73例,真阴性9例;采用128层螺旋CT诊断的灵敏度为97.33％(73/75)、特异度为...     

中央型肺癌的CT增强扫描诊断及价值分析

目的 探讨CT增强扫描在中央型肺癌诊断中的价值.方法 回顾性分析120例中央型肺癌患者的CT增强扫描结果 ,并与常规手术病理的诊断结果 进行比较分析.结果 螺旋CT增强扫描能有效地进行诊断和病理分期,以手术病理诊断结果 为标准,中央型肺癌各分期CT扫描诊断符合率分别为87.7%、80.6%、88.0%、85.7%,平均诊断符合率达85.5%.结论 采用CT增强扫描对各期中央型肺癌进行临床诊断准确率较高,且能进行有效准确分期,值得临床进一步推广和应用.     

Accuracy of Endoscopic Ultrasonography for Determination of Tumor Invasion Depth in Gastric Cancer

Background: Gastric cancer (GC) is one the common lethal cancers in Iran. Detection of GC in the early stageswould assesses to improve the survival of patients. In this study, we attempt to evaluate the accuracy of EUS indetection depth of invasion of GC among Iranian Patients. Materials and Methods: This study is a retrospectivestudy of patients with pathologically confirmed GC. They underwent EUS before initiating the treatment. Theaccuracy of EUS and agreement between the two methods was evaluated by comparing pre treatment EUSfinding with post operative histopathological results. Results: The overall accuracy of EUS for T and N stagingwas 67.9% and 75.47, respectively. Underestimation and overestimation was seen in 22 (14.2%) and 40 (25.6%)respectively. The EUS was more accurate in large tumors and the tumors located in the middle and lower parts ofthe stomach. The EUS was more sensitive in T3 staging. The values of weighted Kappa from the T and N stagingwere 0.53 and 0.66, respectively. Conclusions: EUS is a useful modality for evaluating the depth of invasion ofGC. The accuracy of EUS was higher if the tumor was located in the lower parts of the stomach and the size ofthe tumor was more than 3 cm. Therefore, judgments made upon other criteria evaluated in this study need tobe reconsidered.     

Early Diagnosis and Lung Cancer Screening

Lung cancer remains the most significant cause of cancer death, accounting for about 20% of all cancer-related mortality. A significant reason for this is delayed diagnosis, either due to lack of symptoms in early-stage disease or presentation with non-specific symptoms common with a broad range of alternative diagnoses. More is needed in terms of increasing public awareness, providing adequate healthcare professional education and implementing clinical pathways that improve the earlier diagnosis of symptomatic lung cancer. Low-dose computed tomography screening of high-risk, asymptomatic populations has been shown to reduce lung cancer mortality, with focus now shifting towards how best to implement lung cancer screening on a wider scale in a safe, efficient and cost-effective manner. For maximum benefit, efforts must be made to optimise uptake, especially among high-risk populations with significant socioeconomic deprivation, as well as successfully incorporate tobacco-dependency treatment. Quality assured programme management will be critical to minimising screening-related harms and adequately managing incidental findings. By undertaking the above, there can be optimism that lung cancer outcomes can be improved significantly in the near future.