CT在胃癌局部复发诊断中的应用评价

目的 :评价CT检查在胃癌局部复发诊断中的价值和限度。方法 :2组胃癌术后患者接受了CT检查 ,对照组 15例 ,胃镜和病理未见异常 ,用于测量吻合口胃壁厚度 ,观察胃癌术后吻合口CT表现。胃癌术后复发组36例 ,CT诊断为胃癌术后复发 ,经纤维胃镜和 /或外科手术和病理 ,临床化验检查诊断。男 2 1例 ,女 15例。年龄2 2～ 6 5岁 ,平均 5 3岁。CT检查过程中采用多次服水和低张技术 ,CT增强使用动态或螺旋CT多期扫描的检查方法。结果 :残胃吻合口胃壁厚度为 (0 6 5± 0 16 )cm。胃癌局部复发CT表现为胃壁增厚 (14 / 32 ) ,软组织肿块 (6 /32 ) ,混合性病变 (9/ 32 )。病灶在动脉期不均匀强化 2 1例 ,门脉期渐进性显著强化 2 6例 ,平衡期病灶延迟强化 2 8例。 90 19% (46 / 5 1)吻合口得到良好显示 ,CT检出 32个病灶 ,2 9个病例得到正确诊断 ,漏诊 4例 ,误诊 3例。结论 :采用多次服水、低张 ,CT多期扫描或动态增强扫描技术 ,CT可以良好的显示残胃及吻合口 ,提高残胃吻合口局部复发的显示能力 ,可以总体的提高CT在胃癌复发诊断中的应用价值。

Evaluation of recurrent gastric malignancy with computed tomography

Purpose:To evaluate the role of CT in diagnosing local recurrence after surgery of gastric carcinoma. Methods:Two groups of 51 patients after surgery of gastric carcinoma were prospectively studied by means of CT performed with the water as oral contrast,hypotonic agent and dynamic or spiral CT technique. 15 patients proved to be without local recurrence measured the thickness and observed the CT findings of anastomosis stoma ,36 patients proved to have local recurrence ,those patients included male 21 and female 15.Results:90.19%(46/51)anastomosis stoma was clearly demonstrated ,and 32 lesions was detected and confirmed the diagnosis in 29 of 32 cases . The CT findings of local recurrence after gastric resection for gastric cancer were irregular gastric wall thickening ( n =14),local mass ( n =6) and mixed lesions ( n =9).Conclusions:Using the optimal technique can improve the detectability and accuracy of CT for diagnosing the local recurrence after surgery for gastric carcinoma.