BorrmannⅣ型胃癌超声内镜诊断价值的研究

目的:评价超声内镜(EUS)对 BorrmannⅣ型胃癌的诊断效果。材料与方法:138例胃癌病例术前均经内镜和病理活检检查。其中36例胃镜疑为 BorrmannⅣ型胃癌的病例术前同时做了 EUS 检查,结果与术后外科病理诊断进行对照。结果:胃镜检出的138例胃癌中,Borrmann Ⅰ型、Ⅱ型和Ⅲ型胃癌内镜活检多能明确诊断,第1次活检确诊率达88.5%以上。再次内镜活检取材,97.4%以上的病例能确诊。36例内镜可疑为 BorrmannⅥ型胃癌首次活检14例(38.9%)为粘膜炎症反应,未见癌瘤细胞。虽经再次活检,仍有12例(33.3%)未能获得明确诊断.该型胃癌在 EUS 下声像图常有特征性的变化,表现为大部分或全胃壁弥漫性全层增厚,粘膜下层尤明显,回声减弱。增厚的胃壁并无明显结构紊乱,其层次尚可辨认。根据这一特征,36例内镜疑诊为该型的胃癌病变均行 EUS 检查,均作出了正确的诊断,确诊率达100%。结论:EUS 能显示 BorrmannⅣ型胃癌特征性的变化,用于该型胃癌的诊断,优于内镜及活检检查。

ENDOSCOPIC ULTRASOUND(EUS)DIAGNOSIS OF BORRMANN TYPE 4 GASTRIC CARCINOMA

Purpose:To evaluate the diagnostic value of endosopic ultrasound(EUS)on Borrmann type 4 gas- tric carcinoma.Material and method:138 cases of patients with gastric carcinomas were examined by both endoscopy and biopsy.In which,36 cases of Borrmann type 4 were further carried out for EUS and the results were compared with those of the surgical pathological diagnosis.Results: More than 88.5% gastric cancer with 1,2 or 3 type Borrmann could be diagnosed by first endo- scopic biopsy,while 38.9% Borrmann type 4 couldn't be identified.By the EUS,tumors were i- dentified by thickening and disruption of the typical five-layered configuration of the wall by a hy- poechoic mass.EUS image of Borrmann type 4 gastric cancer was special with diffuse thickness of gastric wall,but the structure and layers could still be identified.When lymph node involved,the round low echo mass with clear margin could be found.All the cases with Borrmann type 4 were correctly diagnosed pre-operation based on EUS examination.Total correct diagnosis rate for this kind of tumor was 100%.Conclusion:EUS is a better and effective way for the diagnosis of the Borrmann types 4 gastric cancer.