食管癌术前分期评价：食管腔内超声,计算机断层扫描？…

比较食管腔内超声计算机断层扫描和临床分期对食管癌术前分期的价值。方法３６例食管癌患者，术前均进行ＥＵ检查，其中８例因管腔严重狭窄末获得全面评估。２１例进行了ＣＴ分期。ＥＵ、ＣＴ和传统临床分期结果分别与手术病理分期比较。结果传统临床分期确率仅为３６％，ＣＴ对肿瘤浸润程度，局部淋巴结受累及ＰＩＮＭ分期的准确率分别为３８．１％、５７．１％和４７．６％，ＥＵ为７７．８％、７２．２％和７０．２％，去除严重狭     

食管腔内超声在食管癌患者中的应用

目的研究经食管探头超声仪（ＴＥＥＰ）在食管癌诊断和治疗中的应用价值。方法１９９６年９月至１９９７年８月,３２例食管癌患者术前进行上消化道钡餐、纤维胃镜和ＴＥＥＰ等检查。其中７例患者术前予以ＣＴ扫描检查。所有患者切除的标本,包括淋巴结,均送病理检查,并将术前ＴＥＥＰ和ＣＴ检查情况与术中、术后病理结果进行对比分析。结果纤维胃镜、ＴＥＥＰ和病理所测的肿瘤长度分别为４５２４±１８０６ｃｍ（ｘ±ｓ）、５２６９±１９１６ｃｍ（ｘ±ｓ）和５３４５±１９０１ｃｍ（ｘ±ｓ）。纤维胃镜测的肿瘤长度与病理结果比较,差异有显著性意义（Ｐ＜００５）,而ＴＥＥＰ测的肿瘤长度与病理结果比较,差异无显著性意义（Ｐ＞００５）。ＴＥＥＰ术前Ｔ、Ｎ分期的准确率分别为８０６％（２５／３１）和７７３％（３３／４４）,而ＣＴ术前Ｔ分期的准确率仅为４２９％（３／７）。结论对于食管癌的术前ＴＮ分期,ＴＥＥＰ是一项可靠的检查手段。ＴＥＥＰ比ＣＴ准确。在测量食管癌肿瘤长度时,ＴＥＥＰ比胃镜精确。该检查手段安全,在我们的临床应用中,未出现任何并发症。     

直肠腔内超声、盆腔CT及磁共振在直肠癌术前分期方面的比较研究

术前准确评估肿瘤对肠壁侵犯程度及区域淋巴结转移情况,才能为直肠癌病人制定最佳治疗方案。该文就直肠腔内超声（ＴＲＵＳ）、盆腔ＣＴ及ＭＲＩ在评估直肠癌术前分期方面的准确率和临床应用价值进行分析和比较。该研究共选取１９９７～１９９８年确诊并手术治疗的８９例直肠癌病人,术前均行ＴＲＵＳ,６９例行盆腔ＣＴ,７２例行ＭＲＩ。三者各自对肿瘤分期做出相应评估,所得结果与病人术后标本病理分期进行对照。判断肿瘤对肠壁侵犯程度,ＴＲＵＳ、盆腔ＣＴ及ＭＲＩ所做分期的总体准确率分别为８１－１％（７２／８９）,６５－２％（…     

磁共振成像对膀胱肿瘤分期的评价

从１９９２年８月至１９９４年８月，采用ＭＲ、ＣＴ、经尿道腔内超志和经腹部超声对２７例膀胱肿瘤患者的３３个肿瘤进行了检查，并分别与术后病理分期结果进行比较。ＭＲ判断肿瘤分期的准确率为９２．５％，ＣＴ为７３．３％，经尿道腔内超声为８８．９％，经腹部超声为６０．０％。结果认为，经腹部超声可用于对膀胱肿瘤的筛选检查，判断肿瘤分期不可靠，经尿道腔内超声对限于膀胱壁以内的肿瘤分期是准确的，而ＣＴ对浸润到膀胱壁     

食管癌术前放化疗后临床再分期的评价

目的探讨食管癌患者术前放化疗（pre-CRT）后采用影像学和内镜检查进行临床再分期的临床价值。方法对27例局部晚期食管鳞癌患者,在接受CRT治疗前采用颈部和胸部及腹部CT、食管超声内镜（EUS）、电子气管镜及PET-CT等检查进行临床分期;完成pre-CRT后再次进行分期。临床疗效评价采用RECIST标准,放化疗后3～6周施行手术,将术后病理结果与术前分期进行对照研究。对常规病理学检测为pT0和pN0病例的组织切片,采用免疫组织化学（免疫组化）染色检测原发灶及淋巴结中的微小肿瘤残留灶。结果全组pre．CRT后,CT对T及N分期的准确率分别为40．9％（9／22）和68．2％（15／22）,总的分期准确率为40．9％（9／22）;EUS对T及N分期的准确率分别为38．5％（5／13）和69．2％（9／13）,总的分期准确率为38．5％（5／13）。联合CT和EUS总的分期准确率为46．2％（6／13）。CRT结束后临床评价完全缓解（CR）5例,部分缓解（PR）14例,无缓解（SD）8例。5例临床评价cR者术后病理证实3例CR,1例pT3N1,1例虽经苏木精．伊红染色为pT0N0,但经免疫组化检测发现淋巴结存在微小肿瘤病灶残留。而术后病理结果pCR的5例患者中,除3例术前评价为CR外。另2例术前临床评价为PR。在15例N0的病例中,免疫组化检测有2例3个淋巴结仍可见食管癌细胞分布于其周边。结论目前常用的临床检查分期手段（食管吞钡、CT、EUS、内镜下病理活检等）和临床疗效评价手段（RECIST标准）对食管癌放化疗后的肿瘤组织反应评价准确率不高。建议CRT后临床评价食管癌CR的患者。仍应接受手术治疗。     

终末期糖尿病肾病患者的肾移植：（附32例报告）

对３２例终末期糖尿病肾病（ＥＳＤＮ）患者进行同种异体肾移植手术，经严格术前选择、取肾、植肾、术后治疗，３０例人／肾存活（９３７％），２例失败（６３％）。１年人／肾存活２７例（８４４％），２年２２例（６８８％），３年１５例（４６９％），５年５例（１５６％）。就ＥＳＤＮ接受肾移植手术的国内外现状、诊断标准及移植肾长期存活等问题进行讨论。     

经腹壁超声在膀胱肿瘤诊断与分期中的意义

行经腹Ｂ超检查临床疑诊为膀胱肿瘤患者２９９例，经与膀胱镜检和术后病理结果对照，２７１例证实为膀胱肿瘤，１０例为非膀胱肿瘤，１８例经腹Ｂ超漏诊。本组经腹Ｂ超诊断准确率为９０．６％（２７１／２９９），误诊率为３．３％（１０／２９９），漏诊率为６．０％（１８／２９９）。经腹壁超声判断膀胱肿瘤分期总的正确率为８８．６％（Ｔ_１期肿瘤８９．１％，Ｔ_２期为８６．８％，Ｔ３期为８７．５％，Ｔ_４期为１００．０％）。经腹壁超声方法简单，患者无痛苦，对膀胱肿瘤诊断与分期的准确性较高，应作为膀胱肿瘤的常规检查方法。     

经尿道前列腺电切术的并发症及其防治

报道经尿道前列腺电切术（ＴＵＲＰ）８７５例的临床资料，年龄４７～８７岁，平均６９．２岁。主要临床表现为进行性排尿困难，夜尿次数增多和尿潴留。术中术后常见并发症的发生率分别为：ＴＵＲ综合征２．７％，包膜穿孔和尿外渗１．７％，切破静脉窦而中止手术０．６％，术中出血和术后继发性出血３．９％，暂时性尿失禁３８％，永久性尿失禁０１％，排尿不畅和尿道狭窄２．１％，阳萎１２０％，逆行射精４５０％。对上述并发症的防治进行了讨论。     

腰椎间盘突出合并侧隐窝狭窄的诊断和治疗

在腰椎间盘突出合并侧隐窝狭窄中,术前明确诊断,选择手术方案,是提高疗效的关键。为此,我们复习了部分ＣＴ片,并进行回顾性分析：１　临床资料１１　一般资料　本组２３例,男１４例,占６０８％,女９例,占３９２％,年龄最大６６岁,最小２４岁,平均４３岁。１２　ＣＴ表现　２３例ＣＴ片均显示有椎间盘突出（术中证实２１例存在椎间突出,２例无突出,仅为单纯性狭窄）。其中５例关节突内聚,黄韧带厚４～１０ｍｍ,侧隐窝矢状径２５～７ｍｍ,病变节段多为Ｌ４－５,Ｌ５～Ｓ１节段少。１３　手术所见　术中见椎间盘…     

Budd－Chiari综合征的病因、诊断、分型和处理

自１９８６年１月至１９９３年４月我们采用ＩＶＣ切开直视根治术证实ＢＣＳ６７例，凡有原因不明的淤血性肝肿大、腹水与躯干浅表静脉上行性曲张者．首应考虑本病．ＢＵＳ、ＣＴ、ＩＶＣＧ可确诊，有定位定性价值．经手术证实ＢＵＳ对ＩＶＣ单纯性病变正确诊断率为９７．０％，复合病变确诊率为８３．６％，病变定位准确率１００％；ＩＶＣＧ定位准确率９５．３％，定性符合率７４．５％．本组病例曾作ＣＴ１０例和ＥＣＴ３例，对病变定位定性诊断尚缺乏经验。术中发现ＩＶＣ膜性梗阻３７例（５５．２％），ＩＶＣ狭窄１５例（２２．４％），单纯栓塞９例（１３．４％，包括癌栓１例），缺损或闭塞３例（４．８％），外压３例（４．８％），其中复合病变２３例（３４．３％）．本组均为ＩＶＣ病变，未发现单纯ＨＶ病变．作者将本病分为５型和５种根治原则：Ⅰ型为膜性梗阻（ＭＯＶＣ，５５．２％），需行膜切除；Ⅱ型为肝段ＩＶＣ狭窄（ＳＶＣ，２２．４％），应行腔静脉扩大成形术；Ⅲ型为ＩＶＣ血栓型（ＴＶＣ，１３．４％），应摘除血栓或癌栓；Ⅳ型为ＩＶＣ缺损型（ＣＶＣ，４．８％），应行血管移植；Ⅴ型为外压型（ＥＰＶＣ，４．８％），应解除外压因素（索带或肿瘤切除等）；各型可有复合型（     

Endoscopic ultrasound for preoperative staging of esophageal carcinoma

Background Endoscopic ultrasound (EUS) is potentially the best method for pretreatment staging of esophageal carcinoma once distant metastases have been excluded by other methods. However, its apparent accuracy might be influenced by the use of neoadjuvant therapy. To determine the accuracy of EUS in patients undergoing esophageal resection, the authors reviewed their experience with EUS. Methods A total of 73 patients with esophageal carcinoma who underwent an esophagectomy between April 2000 and February 2005 were examined using preoperative EUS and computed tomography (CT). Of these patients, 39 also underwent preoperative neoadjuvant chemoradiotherapy. Both EUS and CT scan were used to determine the depth of tumor penetration (T-stage) and the presence of lymph node metastases (N-stage). These results then were compared with staging determined after pathologic examination of the resected surgical specimen. Results For patients not undergoing neoadjuvant therapy, T-stage was accurately determined by EUS in 79%, N-stage in 74%, and tumor node metastasis (TNM) classification in 65% of the cases. However, when patients who had undergone neoadjuvant chemoradiotherapy were included, the overall accuracy of EUS was 64% for T-stage, 63% for N-stage, and 53% for TNM classification. For the patients who underwent neoadjuvant therapy, EUS indicated a more advanced T-stage in 49%, N-stage in 38%, and TNM classification in 51% of the cases, as compared with pathology. The overall accuracy of EUS for T- and N-stage carcinomas was superior to that of CT scanning. Conclusion For patients who do not undergo preoperative neoadjuvant chemotherapy and radiotherapy, EUS is a more accurate method for determining T- and N-stage resected esophageal carcinomas. Neoadjuvant therapy, however, results in apparent overstaging, predominantly because of tumor downstaging, and this reduces the apparent accuracy of EUS (and CT scanning) in this patient group. Nevertheless, EUS staging before neoadjuvant therapy could be more accurate than pathologic staging after treatment, thereby providing better initial staging information, which can be used to facilitate treatment.     

Evaluation of minimally invasive surgical staging for esophageal cancer

BACKGROUND: Conventional imaging studies (computed tomography and endoscopic esophageal ultrasonography) used for preoperative evaluation of patients with esophageal cancer can be inaccurate for detection of small metastatic deposits. We evaluated the efficacy of minimally invasive surgical (MIS) staging as an additional modality for evaluation of patients with esophageal cancer. METHODS: Between December 1998 and February 2001, 33 patients with esophageal cancer were evaluated for surgical resection. Conventional imaging studies demonstrated operable disease in 31 patients and equivocal findings in 2 patients. All patients then underwent MIS staging (laparoscopy, bronchoscopy, and ultrasonography of the liver). We compared the results from surgical resection and MIS staging with those from conventional imaging. RESULTS: MIS staging altered the treatment plan in 12 (36%) of 33 patients; MIS staging upstaged 10 patients with operable disease and downstaged 2 patients with equivocal findings. MIS staging accurately determined resectability in 97% of patients compared with 61% of patients staged by conventional imaging. The specificity and negative predictive value for detection of unsuspected metastatic disease in MIS staging were 100% and 96%, respectively, compared with 91% and 65%, respectively, for conventional imaging studies. CONCLUSION: In addition to conventional imaging studies, MIS staging should be included routinely in the preoperative work-up of patients with esophageal cancer.     

18FDG PET/CT在术前检测食管癌淋巴结转移及分期中的应用

目的观察^18FDG PET/CT在术前检测食管癌淋巴结转移及分期的临床应用价值.方法随机选择拟行手术治疗的食管癌病人30例,术前1周内行^18FDG PET/CT检查,12例病人同期行CT增强扫描,术前均不接受放化疗,根据术后病理对比PET/CT与CT诊断食管癌淋巴结转移及确定淋巴结分期的价值.结果22例存在淋巴结转移,共切取并分离淋巴结243枚,转移淋巴结49枚.PET/CT诊断淋巴结转移的敏感性、特异性、准确性分别为93.9%、91.2%、91.8%,CT分别为40.8%、96.9%、85.6%;PET/CT阳性与阴性预测值分别为73.0%,98.3%,CT为76.9%,86.6%.PET/CT确定淋巴结分期的敏感性、特异性、准确性分别为95.5%、62.5%、86.7%,CT分别为72.7%、75.0%、73.3%.结论18FDG PET/CT图像融合技术诊断食管癌淋巴结转移及确定淋巴结分期临床应用价值优于CT.     

The degree to which accuracy of preoperative staging of laryngeal carcinoma has been enhanced by computed tomography

In this retrospective study, the accuracy of preoperative staging by high-resolution CT and clinical evaluation (indirect-direct laryngoscopy) is compared to the postsurgical pathologic staging of laryngeal cancer. Forty-two patients who were admitted to St. Louis University Hospital between the years of 1978 to 1985 with diagnoses of laryngeal cancer were included. All patients received high-resolution CT scan of the larynx preoperatively and subsequently underwent total or partial laryngectomy. None of these patients received preoperative radiotherapy. The accuracy of the clinical vs. CT staging--as well as the accuracy of the staging by combination of the two modalities--was determined by comparison with the postsurgical pathologic staging. The accuracy was assessed separately for glottic, supraglottic, and transglottic carcinoma. The accuracy of CT staging for glottic carcinoma was 75%. However, clinical evaluation in this group of lesions was very reliable, offering 92.9% accuracy. The accuracy of CT staging increased in the supraglottic and transglottic lesions, to become superior to the clinical staging. With combined information gained by both examinations, the preoperative staging accuracy was 91.4% for supraglottic carcinoma and 87.5% for transglottic carcinoma. It is, therefore, recommended that high-resolution CT should be included in the preoperative staging of laryngeal cancer.     

多层螺旋CT检查对膀胱癌的术前分期价值

目的 评价多层螺旋CT检查对膀胱癌的术前分期价值.方法 回顾性分析经手术病理证实的膀胱癌患者82例.男78例,女4例.均行术前多层螺旋CT检查,将肿瘤CT征象与手术病理分期结果进行对照分析.结果CT检查对膀胱癌的定位和定性诊断准确率分别为78.0%(64/82)和93.9%(77/82).与手术病理结果比较,CT检查判断膀胱周围侵犯、淋巴结转移和邻近器官侵犯的准确率分别为90.2%(74/82)、96.3%(79/82)和89.0%(73/82).CT术前分期与手术病理结果比较呈明显正相关.结论 螺旋CT检查对膀胱癌具有较高的诊断价值,可作为膀胱癌术前常规和主要的检查项目.     

螺旋CT扫描在肾癌术前分期中的应用价值

目的探讨螺旋CT检查在肾癌术前临床分期中的应用价值。方法回顾性分析经手术病理证实的93例肾癌患者资料。男63例，女30例。年龄15～78岁，平均55岁。术前均采用螺旋CT平扫加多期增强扫描。将CT分期与病理分期结果进行比较分析。结果93例患者CT分期Ⅰ期55例、Ⅱ期17例、Ⅲ期6例、Ⅳ期15例；手术病理分期Ⅰ期44例、Ⅱ期28例、Ⅲ期8例、Ⅳ期13例。线性趋势检验结果提示2种分期方法密切相关（P〈0．01），Pearson积矩相关系数rp=0．91，呈正相关关系，但这种关联不是简单的直线关系。螺旋CT对肾癌术前分期的敏感性、特异性和准确性分别为77．4％、92．5％和88．7％。结论螺旋CT能很好地显示肾癌的影像学特征，并进行准确的临床分期，应列为肾癌术前的常规检查项目。     

Evaluation of the accuracy of preoperative staging in thoracic esophageal cancer

Background. Exact clinical staging before treatment of esophageal cancer has become increasingly important in the evaluation and comparison of the results of different treatment modalities, including surgery, chemotherapy, and radiotherapy.

Methods. The accuracy of preoperative tumor staging by using an esophagography, esophagoscopy, percutaneous and endoscopic ultrasonography, and computed tomography was assessed in 224 patients with resectable esophageal cancer. The results of tumor staging by these tests were compared prospectively with the pathologic stage of the esophagectomy specimens with respect to the T and N categories defined by the International Union Against Cancer TNM classification.

Results. For the T category, the overall accuracy was 80%. For the N category, overall accuracy was 72%, with a sensitivity of 78%, a specificity of 60%, and a positive predictive value of 78%. Overall, the accuracy of stage grouping was 56%.

Conclusions. Either the T or N categories can be predicted reliably by clinical staging techniques. However, the preoperative stage grouping might not be valid in resectable, localized esophageal cancer.     

Esophageal ultrasound and the preoperative staging of carcinoma of the esophagus

Esophageal ultrasound allows the esophageal wall to be viewed as five discrete layers. Lymph nodes are easily identified, and their size, shape, margin, and internal structure can be assessed. This provides an alternative method of preoperative (clinical) evaluation of the primary tumor [T] and the regional lymph nodes [N] of patients with carcinoma of the esophagus. Esophageal ultrasound was attempted in the clinical staging of 28 patients with carcinoma of the esophagus. Six patients (21%) were not assessed because of the inability to pass the esophageal ultrasound probe through the malignant stricture. The staging system for carcinoma of the esophagus developed by the International Union Against Cancer and the American Joint Committee on Cancer was used. Twenty-two patients had the true T determined by pathologic review of the resected esophagus. Esophageal ultrasound correctly identified T in 13 patients (59% accuracy). In four patients (18%) the disease was overstaged by esophageal ultrasound; all these patients had early T1 tumors confined to the submucosa. In five patients (23%) the disease was understaged by esophageal ultrasound; all of these patients had advanced tumors (four T3 and one T4) that invaded beyond the esophageal wall. Seven of the nine incorrect esophageal ultrasound determinations were called T2 (three T1, three T3, one T4), which suggests that the borders of the muscularis propria require careful attention when evaluated by esophageal ultrasound. Twenty patients had the true N determined by pathologic review of the resected specimen. Esophageal ultrasound correctly identified N in 14 patients (70% accuracy). Three patients were falsely identified as having N1 disease and three were falsely identified as having N0 disease. The sensitivity, specificity, positive predictive value, and negative predictive value for N assessment by esophageal ultrasound were 70%. Esophageal ultrasound provides an alternative method of visualization of the esophageal wall and regional lymph nodes. Our early experience shows promise for esophageal ultrasound in the clinical staging of carcinoma of the esophagus.     

64层CT三期动态增强扫描对胃癌术前TNM分期的判断价值

目的探讨64层螺旋CT三二期动态增强扫描对胃癌进行术前TNM分期的临床价值．方法回顾性分析2009年5月至2011年5月赣南医学院第一附属医院收治的120例胃癌患者的术前64层螺旋CT三期动态增强扫描资料和术后病理资料,由两名高年资影像科医生采用双盲法进行术前影像学分期。结果术前64层螺旋CT增强扫描对胃癌T分期判断的总体准确率为79．2％（95／120）,其中对T1、T2、T3和T4期判断的准确率分别为66．7％（10／15）、66．7％（14／21）、84．0％（42／50）和85．3％（29／34）。对于单层胃壁结构和多层胃壁结构,CT增强扫描对T分期的准确率分别为59．4％（19／32）和81．8％（72／88）．差异有统计学意义（P〈0．05）。CT增强扫描对N分期判断的总体准确率为73．9％（85／115）,其中对N0N1和N2期判断的准确率分别为75．5％（37／49）、70．3％f26／37）和75．9％（22／29）：对M分期判断的准确率为89．2％（107／120）。结论64层螺旋CTi期动态增强扫描可早期动态观察肿瘤累及侵犯情况、淋巴转移及远处转移的情况．有望成为胃癌术前分期有重要意义的检佥项目之一。