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目的:分析早期胃癌(early gastric carcinoma,EGC)淋巴结转移的危险因素并探讨多排CT(multidetector-row CT,MDCT)对淋巴结转移术前评估的价值.方法:术前行MDCT检查并行根治性胃切除术的EGC患者109例,男64例,女45例,平均年龄56岁,分析患者的临床病理因素与其淋巴结转移的关系,并将MDCT对淋巴结状况的评估结果与病理结果相对照.结果:EGC患者的淋巴结转移率为15.60%,其中黏膜下癌的淋巴结转移率明显高于黏膜内癌(25.00% vs 9.23%,P=0.026).EGC淋巴结转移与患者性别、年龄、肿瘤大小、大体类型、肿瘤位置和组织学类型均无关.受试者工作特征(receiver operating characteristic,ROC)分析进一步显示EGC肿瘤大小对淋巴结转移判断的价值相对较小(曲线下面积为0.63).MDCT对早期胃癌N分期的判断准确率为82.6%,其中N0为85.9%,N1为64.3%,N2为66.7%.MDCT对EGC淋巴结转移判断的敏感度、特异度和准确率分别为70.6%、85.9%和83.5%.MDCT对单发淋巴结转移患者判断的敏感度为50.0%,对1枚以上淋巴结转移患者判断的敏感度为88.9%.MDCT未检出转移淋巴结的EGC患者5例的肿瘤均大于或等于2 cm,其中2例黏膜内癌均为凹陷型.结论:MDCT对EGC淋巴结转移术前评估有较大的临床应用价值,对EGC患者实施微创治疗时,应重视淋巴结转移相关临床病理因素的评估作用.
Objective: To analyze the risk factors of lymph node metastasis in early gastric carcinoma (EGC) and to evaluate the value of multidetector-row CT (MDCT) in the preoperative evaluation of lymph node metastasis.Methods: 109 cases of resection EGC patients, 64 males and 45 females, mean age 56 years old, analysis of the relationship between the clinicopathological factors and lymph node metastasis, and MDCT assessment of lymph node status and pathological results.Results: The rate of lymph node metastasis in EGC was 15.60%, and the rate of lymph node metastasis in submucosal carcinoma was significantly higher than that in mucosal carcinoma (25.00% vs 9.23%, P = 0.026) .CEGC lymph node metastasis was correlated with gender, age, tumor size, gross type , Tumor location and histological type.The receiver operating characteristic (ROC) analysis further showed that the value of EGC tumor size was relatively small (lymph node metastasis) value (0.63) .The lymph node metastasis of early gastric cancer by MDCT The accuracy of staging was 82.6%, with N0 85.9%, N1 64.3% and N2 66.7% .The sensitivity, specificity and accuracy of MDCT in judging lymph node metastasis of EGC were 70.6% 85.9% and 83.5%, respectively.The sensitivity of MDCT in judging patients with single lymph node metastasis was 50.0%, and the sensitivity was 88.9% in patients with lymph node metastasis of more than one.The tumor of 5 patients with EGC without MDCT was 2cm or more, of which 2 cases of mucosal carcinoma were concave type.Conclusion: MDCT of EGC lymph node metastasis preoperative evaluation of great clinical value, minimally invasive treatment of EGC patients should pay attention to lymph node metastasis-related clinical Evaluation of pathological factors.