内镜超声与螺旋CT对直肠癌术前T分期价值的探讨

目的:探讨高频小探头内镜超声(UMP)和多层螺旋CT (MSCT)在直肠癌术前T分期中的临床应用价值.方法:对48例直肠癌患者术前分别行UMP和MSCT检查,并与手术后病理进行对照.结果:UMP和MSCT对T分期判断准确率分别为81.25％和83.33％.UMP和MSCT对早期直肠癌的诊断准确率分别为88.89％和77...     

超声内镜在胃癌诊断和分期中的价值

目的：评估超声内镜在胃癌诊断中的应用价值.方法：106例患者于术前行超声内镜、胃镜检查与组织活检病理检查,并将其分期结果与术后病理学检查分期结果比较.结果：胃镜结合病理活检诊断率93.4%（99/106）,超声内镜诊断率为85.0%（90/106）.两者联合运用诊断率为100%.超声内镜对胃癌术前分期结果准确率达到81.1%（86/106）;淋巴结转移准确率为72.2%（70/97）.结论：超声内镜对诊断胃癌有较高的临床价值,并可有效地判断胃癌的分期和淋巴转移状况.     

术前超声内镜对早期胃癌浸润深度的诊断价值及其影响因素分析

[目的]探讨超声内镜对早期胃癌浸润深度诊断的准确性及影响因素分析。[方法]回顾性分析2012-2013年行术前超声内镜检查且超声内镜分期为T1、术后获得明确病理诊断为早期胃癌临床病例138例,比较超声内镜与病理判断肿瘤黏膜下浸润的一致性,以及影响超声内镜分期准确性的相关因素。[结果]在138例病例中,超声内镜诊断黏膜下层受侵与否的准确率为71.74%,特异性为76.67%,灵敏度为62.5%。肿瘤大小和分化程度与过度分期和分期不足相关。[结论]对早期胃癌浸润深度的诊断,超声内镜具备临床应用价值。肿瘤大小、病理分化程度影响术前超声内镜分期的准确性。     

内镜超声检查在早期胃癌术前分期的应用

目的　探讨内镜超声检查 (EUS)在早期胃癌术前分期中的临床应用价值。方法　对14 9例经胃镜活检证实的胃癌患者 (其中早期胃癌 33例 )术前行内镜超声检查 ,并与术后病理检查结果对照。结果　EUS对胃癌T分期的准确率为 80 .3% ,其中T1期为 81.8% ,T2期为 70 .4 % ,T3期为88.9% ,T4期为 71.4 %。EUS鉴别早期和进展期胃癌的准确率达 95 .1% ,而鉴别胃黏膜和黏膜下癌的准确率仅为 6 3.6 %。EUS对黏膜和黏膜下癌的判断准确率分别为 5 2 .9%和 75 .0 % ,而阳性预测值分别达 90 .0 %和 70 .6 %。EUS对隆起型和平坦型早期胃癌浸润深度的判断准确率均为 10 0 % ,对凹陷型的准确率仅 5 8.6 % ;对分化型和未分化型早期胃癌浸润深度的判断准确率分别为 71.4 %和5 7.9% ,差异无显著性 (P >0 .0 5 )。EUS对早期胃癌浸润深度的判断准确率随着肿瘤直径的增大而降低 ,对早期胃癌淋巴结状况的判断准确率为 90 .9% ,对淋巴结转移的敏感性和特异性分别为 6 6 .7%和 96 .3%。结论　内镜超声检查对早期胃癌术前分期具有较高的临床应用价值。     

胃窗超声造影与常规超声检查在胃癌术前T分期中的应用比较

 目的　探讨胃窗超声造影在胃癌术前T分期诊断中的应用价值。方法　回顾性分析经手术病理确诊的62例胃癌患者资料,术前分别行胃窗超声造影及常规超声检查,将两种检查方法的结果与术后病理对照。结果　胃窗超声造影和常规超声对胃癌病灶的检出率分别为100.0 %（62／62）与64.5 %（40／62）,两者差异有统计学意义（χ2＝24.369,P＜0.05）。胃窗超声造影和常规超声对T1期、T4期分期准确率分别为85.7 %（6／7）、0及92.3 %（36／39）、59.0 %（23／39）,差异均有统计学意义（均P＜0.05）;对T2、T3期的分期准确率分别为75.0 %（3／4）、0及83.3 %（5／6）、33.3 %（2／6）,差异均无统计学意义（P＝0.143,P＝0.242）。结论　胃窗超声造影对胃癌检出率明显高于常规超声,且在胃癌的术前T分期诊断中具有较高的准确率,有助于指导临床合理施治,是值得推广的无创、便捷的胃部疾病普查手段。     

胃癌术前超声内镜评估TNM分期的临床研究

为了评估超声内镜在胃癌术前分期评估中的作用,83例胃癌患者均于术前行超声内镜检查,并将其内镜分期结果与术后病理学检查分期结果比较.超声内镜分期结果与病理学分期结果比较显示,各期准确率分别为T1期88.9%(8/9),T2期91.2%(21/23),T3期81.5%(31/38),T4期92.3%(12/13);淋巴结转移准确率为78.9%.超声内镜检查可有效进行术前分期,有助于制订合理的治疗方案.     

多层螺旋CT在胃癌术前分期诊断中的价值研究

目的评价多层螺旋CT(MSCT)检查在胃癌术前分期诊断中的价值。方法对87例经胃镜活检证实的胃癌患者行MSCT平扫和增强扫描,并由两名有经验的医师进行TNM分期,其中69例与其手术后病理结果进行对比。结果 MSCT对胃癌术前T、N、M及TNM总分期诊断准确率分别为76.8%、82.6%、100%和82.6%,均与手术病理相一致(Kappa值分别为0.644,0.705,1.000和0.750)。结论 MSCT对胃癌的诊断有其一定的优越性,可提高胃癌术前TNM分期的准确性,是胃癌术前准确分期的可靠方法,可以指导胃癌患者的治疗。     

多层螺旋CT与内镜超声检查对胃癌的术前评估价值比较

目的:比较多层螺旋CT与内镜超声检查对胃癌的术前评估价值。方法:采用回顾性总结研究方法，选择2014年6月至2018年1月在我院普外科手术切除并经病理证实的胃癌患者66例作为研究对象，记录所有患者的多层螺旋CT与内镜超声检查结果，并与病理检查结果进行对比分析。结果:在66例患者中，T分期为T1期6例，T2期14期，T3期30例，T4期16例；N分期为N0期16例，N1期14期，N2期36例；M分期为M0期46例，M1期20期。内镜超声对TNM分期判断准确率分别为92.4%、92.4%和93.9%，CT对TNM分期判断准确率分别为93.9%、97.0%和98.5%，CT都好于内镜超声，但是对比差异无统计学意义(P＞0.05)。结论:多层螺旋CT与内镜超声检查在胃癌TNM分期的术前评估都有较高的准确率，在临床上可结合两者方法共同使用，以提高诊断效果。     

多层螺旋CT和超声内镜对食管癌术前评估及手术方案选择的随机对照研究

目的:食管癌术前临床分期对选择合理治疗方案至关重要,微探头超声内镜（mini-probe endoscopic ultrasonography ,MCUS）对食管癌T、N 分期诊断准确率高,目前已成为国外食管癌治疗前的常规诊断和分期方法,本研究比较多层螺旋CT（multi-slice computer tomography,MSCT）与MCUS对食管癌患者术前评估的价值以及对手术方案预测的意义。方法:前瞻性纳入明确诊断为食管癌158 例患者。随机分为MSCT组（A 组）和MCUS组（B 组）各79例,术前均行X 线钡餐、消化道内镜活检外,再分别接受MSCT检查和MCUS检查,据此进行术前分期和手术方案的预测,并与术后病理分期和实际手术方案比较。结果:实际纳入152 例,A 组（75例）和B 组（77例）间基线特征差异无统计学显著性（P>0.05）。 术前T 分期准确度A 组60.00% ,B 组84.41% ,两组间差异有显著性统计学意义（P=0.001）。 术前N 分期准确度A 组77.33% ,B 组83.12% ,两组比较差异无统计学意义（P=0.370）。对手术方案预测的准确度A 组73.33% ,B 组89.61% ,两组间有统计学差异（P=0.010）。 结论:MCUS对食管癌术前分期、手术方案的预测准确度高于MSCT,从而为临床选择合理治疗方案具有一定的指导意义,建议有条件的医院对食管癌患者进行常规MCU检查。      

超声诊断在胃癌术前分期中的价值

目的 探讨胃癌分期中超声检查的诊断价值.方法 对31例胃癌患者进行术前超声诊断,并与术后病理检查进行对比分析.结果 超声对胃癌分期诊断与术后病理符合率为80.6%,其中T1、T2、T3、T4各期判断符合率分别为66.7%、60.0%、88.9%、80.0%;超声对胃癌淋巴结转移的诊断准确率为83.8%.结论 超声对胃癌术前分期提供了重要依据,对临床选择治疗方案和手术切除范围有重要价值.     

超声内镜对消化道早期癌的诊断价值

目的：探讨超声内镜对消化道早期癌的临床诊断价值。方法对90例消化道早期癌患者的内镜检查及临床资料进行回顾性分析,以术后病理诊断为标准,探讨超声内镜对消化道肿瘤的临床早期诊断及分型诊断价值。结果超声内镜检查对食管癌、胃癌和结直肠癌的临床诊断的准确率为85．3％、88．9％、86．2％,均明显高于常规内镜检查结果。超声内镜对早期食管癌分型结果与术后病理学检查证实的符合率为85．3％（29／34）;其对早期胃癌的分型诊断结果表明早期胃癌以浅凹陷（Ⅱc）为主（40．7％）,浸润深度以黏膜内癌为主（63．0％）,组织学以低分化腺癌较多（74．1％）;与病理学分期诊断比较,超声内镜对29例早期结直肠癌患者的诊断准确为72．4％（21／29）。结论超声内镜对消化道早期癌的诊断价值较高,对其临床指导治疗具有重要的意义,值得进一步推广和应用。     

Stomach One-Point Cancer: One Case Report and Literature Review

Introduction Gastric cancer is one of the common cancers and one of the most frequent causes of cancer deaths worldwide.Early detection and accurate preoperative staging of gastric cancer is essential for planning optimal therapy such as endoscopic mucosal resection or gastric resection and offers the best prognosis.     

Radiographic and endoscopic diagnosis of gastric cancers in the esophago-gastric region

The basic study for x-ray diagnosis and endoscopic one of early gastric cancer in the cardiac region was made. 30 cases of early gastric cancer were investigated for this purpose. The half-standing prone right anterior oblique projection and the half-standing supine left anterior oblique one were indispensable in routine x-ray examinations to detect the early gastric cancer in the cardiac region. Such findings as irregularly shaped barium fleck or irregular collection of the barium with faint granularity should carefully be checked up in terms of x-ray diagnosis of early gastric cancers in the cardiac region. Such findings as reddish discoloration and mucosal unevenness should carefully be checked up in terms of endoscopic diagnosis of early gastric cancers in the cardiac region.     

Staging and preoperative evaluation of upper gastrointestinal malignancies

Esophageal and gastric cancers are distinct carcinomas of the upper gastrointestinal tract, although the distinction between them becomes less clear at the gastroesophageal junction (GEJ). Increasingly accurate staging is possible based on newer radiographic and surgical techniques such as positron emission tomography (PET), laparoscopy and thoracoscopy, laparoscopic ultrasound, and endoscopic ultrasound (EUS). For both cancer types, tumor classification is determined by depth of penetration of the primary tumor into the gastric or esophageal wall. For esophageal cancer, primary tumor anatomic position-upper, mid, and lower esophagus-is used to define the local nodal basin. Metastases in nodes outside the local basin are considered to be distant (M) rather than regional (N). In gastric cancer, the region of nodal metastasis has been abandoned in favor of the number of lymph nodes containing metastasis, which predicts outcome more accurately-patients with more than 15 positive lymph nodes have an outcome comparable to those with M disease. Increasing consideration is being given to the subclassification of tumors near the GEJ into types based on anatomical position, although this staging scheme ("Adenocarcinoma of the EsophagoGastric junction" or AEG type) has not yet been universally adopted. We review the current pathologic staging systems for esophageal and gastric cancers, the clinical staging approaches for these diseases, and the controversy surrounding classification of tumors of the GEJ.     

Depth-predicting score for differentiated early gastric cancer

Background  

Intramucosal and minute submucosal (M-SM1; <500 μm in depth) differentiated gastric cancers, which have a negligible risk of lymph node metastasis, are the targets for endoscopic resection. However, there have been few reports about the endoscopic distinction between these cancers and cancers with deeper submucosal invasion (SM2; ≥500 μm in depth). The aim of this retrospective study was to analyze the differences in the endoscopic features between M-SM1 and SM2 cancers, and to develop a simple scoring model to predict the depth of these early gastric cancers.     

Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type,depth of wall invasion,and lymph node metastasis

Background Limited surgery by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for gastric cancer is frequently performed in many institutions. These techniques do preserve gastric function and maintain a high quality of life but may compromise survival. The treatment strategy for early tumors should therefore be based on a complete cure, and limited surgery must thus have clear indications. Methods D2 gastric resection was performed in 278 early gastric adenocarcinomas, and a retrospective histological review of the specimens was made. The extended indications for EMR or ESD, according to the Japanese Gastric Cancer Association Treatment guidelines for gastric cancer in Japan, were also assessed. Results Of the 278 early gastric cancers, 115 were mucosal (M) cancers without ulcer. No lymph node metastases were seen in these specimens. Six of the 41 specimens of M cancer with ulcers had lymph node metastases at the N1 level only. One of these had lymph node metastases from a tumor measuring less than 3 cm in size. Twenty-eight of 122 submucosal cancers had lymph node metastases (23%). Twenty of these were SM1 tumors and 5 had lymph node metastases; 4 of these 5 had lymph node metastases despite the absence of vascular invasion. Conclusion Three cases had lymph node metastases that met the extended criteria for EMR/ESD. EMR and/or ESD should be limited to M cancers without ulcer or differentiated-type M cancer with ulcers smaller than 2 cm. When the depth of tumor invasion is deeper than M, then a gastric resection with lymph node dissection is necessary.     

Clinicopathological Characteristics of Synchronous Multiple Gastric Cancers in Chinese： An Analysis of 44 Cases

Objective: To investigate the clinicopathologic characteristics of the primary synchronous multiple gastric cancers (SMGC) in Chinese.Methods: Clinicopathologic data of patients with histologically confirmed gastric cancer who received surgical operations in our department between 1993 and 2002 were retrospectively collected and analyzed. Clinicopathologic characteristics including gender, age, tumor location, differentiation and staging between patients with SMGC and those with solitary gastric cancer (SGC) were compared. Synchronous multiple and solitary gastric cancers were diagnosed and classified based on radiography upper endoscopy and histology. All the cases were followed up after the operation and 5-year survival rate between the two groups was compared.Results: A total of 871 patients with gastric cancer were included. Synchronous multiple gastric cancers were found in 44 (5.1%) of these cases. More of the diagnose in the early stage to SMGC than to SGC. SMGC were more likely to be located at the lower third stomach and of a low grade differentiation, compared to SGC. However, there were no significant differences in the rates of lymph node metastasis and lymphatic vessel invasion between multiple and solitary gastric cancers. In addition, the 5-year survival rate did not difference between the two groups.Conclusion: The whole stomach should be detected carefully to avoid missing out the multiple gastric cancers. Concerning the treatment of multiple gastric cancer, the sufficient extent of the stomach wall resection was necessary, and the extent of lymphadenectomy was supposed to follow the operation for the solitary gastric cancer according to the staging of the cancer lesions.