体表超声对食管胃结合部腺癌术前评估的应用价值

发布时间：2018-01-11 02:03

  本文关键词：体表超声对食管胃结合部腺癌术前评估的应用价值　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 体表超声 食管胃结合部腺癌 分型 TNM分期 分化程度

【摘要】：目的探究经腹体表超声在食管胃结合部腺癌术前评估的临床应用价值及观察食管胃结合部腺癌在体表超声下的形态学表现。方法收集安徽医科大学第一附属医院2014-12/2016-05接受手术切除的65例经胃镜初诊的食管胃结合部腺癌(Adenocarcinoma of esophagogastric junction,AEG)患者,所有研究对象均于术前行体表超声(transabdominal ultrasoud,TUS)和CT检查,术后均行病理检查,观察AEG的形态学表现并结合术后病理对AEG分型、TNM分期、肿瘤分化程度及肿块大小方面进行分析对比。结果65例AEG患者在癌胚抗原、糖类抗原19-9、肿瘤大小以及胸骨下角方面,各型间差异无统计学意义(均P0.05)。大体标本BorrmannⅢ型31例,占47.7%,BorrmannⅡ型15例,占23.1%,组织学标本低分化腺癌29例,占44.6%,中分化腺癌19例,占29.2%;参照Siewert分型,TUS和CT对AEG临床分型诊断正确率分别为90.8%、92.3%,其中Ⅰ型分别为85.7%、92.9%,Ⅱ型分别为91.4%、88.6%,Ⅲ型分别为93.8%、100%,两者诊断AEG分型存在一致性,差异有统计学意义(Kappa=0.852,P0.05);TUS及CT对AEG T分期的诊断准确率分别为33.8%、63.1%,其中T1-3分别为29.4%、52.9%;T4分别为35.4%、66.7%,两者在T分期诊断中差异有统计学意义(χ2=10.85,P=0.001),但在术前诊断为低分化的腺癌的AEG患者中,TUS与CT在T分期诊断中差异无统计学意义(χ2=0.26,P=0.61)。TUS及CT对AEG N分期的诊断准确率分别为38.5%、50.8%,其中N0分别为87.5%、91.7%;N+分别为9.8%、26.8%,两者在N分期诊断中差异无统计学意义(χ2=0.07,P=0.79)。TUS及CT对AEG M分期的诊断正确率均为98.5%。体表超声测量肿瘤最长径为4.00cm±1.84cm,术后病理测量肿瘤最长径为4.41cm±2.52cm,两者差异无统计学意义(t=-1.512,P0.05)。结论术前TUS能准确判断AEG的分型,有助于临床制定手术路径,对AEG的N、M分期有较高的临床应用价值;当AEG患者术前胃镜初诊为低分化腺癌时,体表超声和CT均可用于术前TNM分期;另外,体表超声也是测量AEG肿瘤大小的可靠检查手段,对于指导手术以及判断预后有很大意义。
[Abstract]:Objective to investigate the clinical value of transabdominal surface ultrasound in preoperative evaluation of esophageal and gastric junction adenocarcinoma and to observe the morphological features of esophageal and gastric junction adenocarcinoma under body surface ultrasound. Methods the first affiliated Hospital of Anhui Medical University was collected. Operative resection of 2014-12 / 2016-05: a report of 65 cases of esophageal and gastric junction adenocarcinoma (newly diagnosed by gastroscopy). Adenocarcinoma of esophagogastric junction. All patients were examined by transabdominal ultrasound (TUSS) and CT before operation, and pathological examination was performed after operation. The morphologic features of AEG were observed and compared with pathological changes in AEG classification, tumor differentiation and tumor size. Results 65 patients with AEG had carcinoembryonic antigen (CEA). There was no significant difference in the size of tumor and the inferior sternum angle between the three groups (all P 0.05). There were 31 cases of Borrmann 鈪，

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