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目的探讨64排螺旋CT(MSCT)增强扫描对进展期胃癌术前TNM分期的判断价值,以指导临床手术可切除性和根治范围。方法选择延安大学附属医院普外科2011年9月至2014年2月经胃镜及病检确诊为进展期胃癌患者168例,术前1周行MSCT增强扫描,根据结果作出TNM分期诊断,并与手术后病理TNM分期对照。结果MSCT增强扫描对胃癌T分期总正确率为82.1%,T1、T2、T3、T4分期准确率分别为74.1%、68.2%、87.1%、86.0%。N分期的准确率为73.2%,N0、N1、N2分期准确率分别为74.5%、70.1%、76.0%;M0准确率高达100%,M1准确率为85.7%,两者比较有统计学差异(P<0.05)。结论 MSCT增强扫描评估进展期胃癌术前TNM分期的准确性高,尤其对远处转移判断与手术病理有高度一致性,对进展期胃癌术前可切除性和根治范围的评估及制定手术方案均有很高的临床参考价值及意义。
Objective To investigate the diagnostic value of 64-slice spiral CT (MSCT) enhanced scan for the preoperative TNM staging of advanced gastric cancer to guide the clinical resectability and radical treatment. Methods A total of 168 patients with advanced gastric cancer who underwent endoscopy and pathology were enrolled in the Department of General Surgery, Affiliated Hospital of Yan’an University from September 2011 to February 2014. MSCT enhanced scan was performed one week before operation. TNM staging was diagnosed according to the results. Pathological TNM staging control. Results The overall accuracy of T stage staging of gastric cancer was 82.1%. The staging accuracy of T1, T2, T3 and T4 were 74.1%, 68.2%, 87.1% and 86.0% respectively. The accuracy of N staging was 73.2%, and the staging accuracy of N0, N1 and N2 were 74.5%, 70.1% and 76.0% respectively. The accuracy of M0 was as high as 100% and the accuracy of M1 was 85.7% P <0.05). Conclusions MSCT enhanced scan can assess the accuracy of preoperative TNM staging of advanced gastric cancer. In particular, it is highly consistent with the distant metastasis judgment and surgical pathology. The preoperative resectability and radical curative evaluation of advanced gastric cancer and the development of surgical plans Have a high clinical reference value and significance.