64排螺旋CT三期增强扫描在胃癌淋巴结清扫术前评估中的价值

目的:探讨64排螺旋CT三期增强扫描在胃癌淋巴结清扫术前评估中的价值.方法:确诊为胃癌的患者,术前行64排螺旋CT三期增强扫描,通过容积再现三维血管成像了解腹腔干3大动脉及其分支(肝总动脉、肝右动脉、肝左动脉、脾动脉、胃左动脉)的解剖走行情况,用分组定位法检出淋巴结,进行N分期,与术后病理分期相对照.结果:38例胃癌患者术前行64排螺旋CT三期增强扫描及通过容积再现三维血管重建成像评估3大动脉分支及其属支走行情况,术中探查验证,准确率为100%;通过与术后病理对照,在判断胃癌胃周有无淋巴结转移的准确率为:92.1%(35/38);对胃癌N0-N3b分期及N分期的准确率分别为71.4%(5/7)、62.5%(5/8)、81.82%(9/11)、75%(6/8)、25%(1/4)及68.42%(26/38).结论:64排螺旋CT三期增强扫描能较客观地评估胃癌患者术前腹腔干3大动脉及其分支的解剖走行情况及对胃周淋巴结有无转移做出比较可靠的判断,对指导术中淋巴结清扫、减少术中动脉损伤等方面有重要的作用.

Value of 64-slice spiral CT triple-phase enhanced scanning for preoperative evaluation of lymph node dissection in patients with gastric cancer

AIM: To analyze the value of 64-slice spiral computed tomography (CT) triple-phase enhanced scanning for preoperative evaluation of lymph node dissection in patients with gastric cancer. METHODS: Thirty-eight patients with gastric cancer underwent preoperative 64-slice spiral CT triple-phase enhanced scanning to comprehend the anatomic distribution of the celiac trunk, its three branches and their tributaries (common hepatic artery, right hepatic artery, left hepatic artery, splenic artery, and left gastric artery) through volume rendering and three dimensional vascular imaging. The lymph nodes were detected using group orientation method, and N staging was performed to compare with postoperative pathological results. RESULTS: Surgical results verified that 64-slice spiral CT triple-phase enhanced scanning through volume rendering and three dimensional vascular imaging had an accuracy rate of 100% in preoperative evaluation of the distribution of the celiac trunk, its three branches and their tributaries. Compared to postoperative pathological results, the accuracy rate was 92.1% (35/38) in evaluating perigastric lymph node metastasis, and 71.4% (5/7), 62.5% (5/8), 81.82% (9/11), 75% (6/8), 25% (1/4) and 68.42% (26/38) in preoperatively evaluating stages N0-N3b and N gastric cancer, respectively. CONCLUSION: Preoperative 64-slice spiral CT triple-phase enhanced scanning is an objective way to assess the distribution of the celiac artery trunk and related tributaries in patients with gastric cancer, and it allows to reliably judge whether there is perigastric lymph node metastasis and can guide intraoperative lymph node dissection and reduce intraoperative injury to the artery.