超声造影在胃癌诊断及术前TNM分期中的应用价值

目的探讨超声造影在胃癌诊断及术前TNM分期中的价值。方法 86例胃癌患者术前进行胃超声造影检查及TNM分期,并与术后病理进行对照分析。结果胃超声造影诊断胃癌检出率为97.67%,T、N、M分期总符合率分别为65.12%、66.28%、94.12%。对T_1、T_2、T_3、T4_期诊断符合率分别为42.86%、60.00%、66.67%、80.00%;对N分期诊断的符合率分别为N_0为85.71%、N_1为51.72%、N_2为73.33%、N_3为57.14%。结论超声造影对胃癌诊断、术前TNM分期与术后病理诊断及分期具有较高的符合率,具有较高的临床应用价值。     

超声双重造影在胃癌术前诊断和临床分期的初步应用研究

目的 探究超声双重造影在胃癌术前诊断和临床TNM分期中的应用价值.方法 对浙江大学医学院附属第二医院普外科2011年7月至2011年9月期间入院的13例胃癌患者术前进行胃超声双重造影检查及TNM分期,并与术后病理作对照分析.结果 超声双重造影检查对胃癌诊断准确率为100％(13/13),包括早期胃癌1例,进展期胃癌12例;对胃癌浸润深度分期总符合率为76.9％(10/13),检出癌灶直接浸润肝脏2例、网膜1例,3例浸润深度出现偏差的肿瘤均位于胃底或胃大弯;对淋巴结转移阳性的诊断准确率为66.7％(2/3),对淋巴结转移与否诊断的总体符合率为92.3％(12/13).结论 超声双重造影对胃癌的诊断以及术前临床分期具有较高的准确率,可做为进展期胃癌术前常规筛查手段,但对于胃大弯和胃底部病灶的TNM分期符合率相对偏低.     

胃癌孤立淋巴结转移的影像研究

[目的]评价CT在胃癌孤立淋巴结转移中的诊断作用。[方法]回顾性分析胃癌孤立淋巴结转移患者75例临床资料。[结果]75例患者中,68例淋巴结转移位于胃周（N1）。另有7例患者淋巴结跳跃转移至N2～N3站,CT对孤立淋巴结转移胃癌患者T分期、N分期及M分期的准确率分别为73-3％、78．7％和90％。[结论]并非每个前哨淋巴结都位于胃周原发病灶附近。CT在孤立淋巴结转移胃癌患者TNM分期上的准确性较高。     

胃癌术前分期的B超诊断评估

目的：判定进展期胃癌切除的可能性和／或手术方式的选择。方法：本组34例均经Pentax胃镜检查，活检确诊为胃癌，术前应用ATL Apogee800彩色B超应用变频探头对其进行检查，肿瘤的胃壁浸润情况和淋巴结转移情况判定B超TN期，分别与病理TN期比较。结果B超诊断肿瘤大小与手术所见符合率83．3％，T期准确度分别为T2 50％，T3 76．4％，T4 62．5％，总符合率达87．5％，N期准确度N1 80％，N2 75％总符合率75％以上。结论：高性能B超有助于对胃癌的术前分期，对手术切除可能性的判断和转移淋巴结的清除，以及预后有重要价值。     

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。     

超声应用有回声型助显剂诊断胃癌的应用价值

目的：探讨超声利用有回声型助显剂诊断胃癌的应用价值。方法：对40例胃癌患者的超声声像图进行回顾性分析,并将超声判断TNM分期结果与病理结果进行分析比较。结果：超声对胃癌浸润深度判断总的符合率为75.00％,对T1、T2、T3、T4期诊断符合率分别为66.67％、60.00％、80.00％、83.33％,对淋巴结转移及远处转移诊断符合率分别为67.50％和100％。结论：超声利用有回声型造影剂有利于判断胃癌TNM分期,具有临床应用价值。     

胸段食管癌临床分期与病理TNM分期对比研究

目的：探讨胸段食管癌临床分期的准确性并结合病理TNM分期进行对比分析方法：58例可切除胸段食管癌．术前行钡餐造影、胸部CT扫描和腹部超声波检查，根治术后病理均为鳞状细胞癌病理TNM分期：Ⅱa期28例占483％，Ⅱb期2例占3．4％，Ⅲ期27例占46．6％，Ⅳ期1例占1．7％．术前临床分期：Ⅱ期27例占46．6％，Ⅲ期28例占483％，Ⅳ期3例占5．2％采用方差分析和相关性检验统计两种分期的相关性和符合性结果：术后病理T分期与术前临床T分期的相关性不明显r=-0．233，P=0．079；而术后病理N分期与术前临床N分期具有显著性相关r=0．285．P=0．030；病理TNM和临床TNM分期有显著性相关r=0．289，P=0．028术后病理淋巴结转移者30例占51．7％．术前CT片淋巴结肿大者33例占56．9％．二者具有显著性相关r=0．388，P=0．003病理TNM分期和临床TNM分期均呈现分期越晚转移淋巴结个数越多，同样钡餐造影的病变长度也随期别越晚，病变长度越长。且有统计学意义。临床T分期与CT片显示的肿大淋巴结个数和术后病理淋巴结转移个数均具有显著性相关r=0．289，P=0．028和r=0．298．P=0．023，然而病理T分期与淋巴结转移并未显示相关性结论：两种分期系统有一定相关性和符合率，但仍存在较大差距，主要是病变局部T分期在早期病例的符合率较差，内窥镜超声介入可能会有所帮助。     

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。     

Gastric cancer

To prove the efficacy of adjuvant therapy for curatively resected advanced gastric cancer, large-scale randomized control trials are necessary based on the idea of EBM (Evidence Based Medicine). We had a long history of adjuvant therapy and many trials were conducted so far. However, many problems were also pointed out in past trials, even in the several trials with positive results. After accumulation of the knowledge of a good clinical trial, we started to organize study groups like JCOG (Japan Oncology Group) for high-quality clinical trials in Japan. The positive result of the National Surgical Adjuvant Study of Gastric Cancer (N. SAS-GC) is encouraging after the long period of negative results from adjuvant trials. This trial was well designed randomized clinical trial (RCT) with statistically significant difference of survivals,which suggest the efficacy of the adjuvant chemotherapy with UFT. However, because of the reduced sample size of this trial, we need one more trial with sufficient sample size to prove the efficacy of adjuvant chemotherapy for gastric cancer as the definitive evidence.     

Gastric adenocarcinoma

In spite of the declining incidence of gastric adenocarcinoma observed during the last 30 years in the U.S., this disease continues to carry a very bleak prognosis. Even with the best forms of treatment, the overall survival remains approximately 7%.Epidemiologic data within the past decade have given considerable new insight into the carcinogenesis of gastric cancer in high-risk areas worldwide as it relates to in vivo nitrate conversion to precarcinogens or carcinogenic substances. It is hope that further epidemiologic information will help to identify specific preventive measures to eliminate those environmental dietary factors that contribute to the incidence of gastric cancer in certain endemic areas.The only hope for cure after a diagnosis of gastric cancer is established lies with an extirpative surgical procedure possibly combined with an adjuvant chemotherapeutic regimen. In the presence of incurable disease, the best form of palliation is achieved with resection of the primary tumor, short of total gastrectomy. Palliative bypass procedures do not increase survival and any hope of improving the quality of life is highly question-able.Adjuvant forms of therapy using the known chemotherapeutic agents active against gastric adenocarcinoma provide the most likely means of improving survival associated with gastric cancer.     

Gastric carcinoma

Although gastric cancer is still a worldwide major public health concern, it remains relatively uncommon in the Western countries. Despite improvement in surgical morbidity and mortality, as well as significant advancement of chemotherapy and radiotherapy options, the survival for gastric cancer has not significantly improved over the past decades. In the United States, standard of care for localized resectable gastric cancer is with adjuvant chemoradiotherapy. In this article, we summarize salient randomized and phase II and III clinical trials representing current treatment for gastric cancer.     

Gastric cancer

With the development of related instruments and techniques, laparoscopic surgery has come to be applied to treatment of gastrointestinal malignancies as a minimally invasive surgery. For early gastric cancers with negligible risk of lymph node metastasis, endoscopic mucosal resection (EMR), laparoscopic wedge resection (LWR), and laparoscopic intragastric mucosal resection (IGMR) have been performed. For those with fairly sizable risk of lymph node metastasis, laparoscopy-assisted distal gastrectomy (LADG) is applied. Our studies have suggest that LADG is more useful than open distal gastrectomy in the management of patients with gastric cancer from the viewpoints of curability, minimal invasiveness, and quality of life of patients.     

Gastric carcinoid

PURPOSE OF REVIEW: Gastric carcinoid tumors are rare lesions but have been the focus of much scientific investigation. The incidence of gastric carcinoid appears to be increasing without a corresponding increase in survival, despite utilization of the latest available therapies. Therefore, there is great interest in furthering the understanding of the biologic basis of these tumors, delineating the connection between hypergastrinemia and gastric carcinoids, and most importantly, improving upon current treatment options. RECENT FINDINGS: This review discusses the current biologic understanding of gastric carcinoid tumors, including the role of hypergastrinemia on enterochromaffin-like cell proliferation and its relation to acid-suppressive therapy. Numerous diagnostic and therapeutic modalities including endoscopic ultrasound, somatostatin receptor scintigraphy, long-acting octreotide, hepatic artery embolization, endoscopic mucosal resection, and surgical resection have also been the focus of recent investigations. SUMMARY: Despite the many advances that have been made in both the basic science and clinical arenas, the optimal treatment of gastric carcinoid tumors is still a matter of debate. As the understanding of the biologic basis of gastric carcinoid tumors increases, the treatment will likely be a multimodal approach tailored to individual tumor biology and will incorporate a variety of diagnostic and therapeutic modalities.