本文關(guān)鍵詞：體表超聲對食管胃結(jié)合部腺癌術(shù)前評估的應(yīng)用價值　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 體表超聲 食管胃結(jié)合部腺癌 分型 TNM分期 分化程度

【摘要】：目的探究經(jīng)腹體表超聲在食管胃結(jié)合部腺癌術(shù)前評估的臨床應(yīng)用價值及觀察食管胃結(jié)合部腺癌在體表超聲下的形態(tài)學(xué)表現(xiàn)。方法收集安徽醫(yī)科大學(xué)第一附屬醫(yī)院2014-12/2016-05接受手術(shù)切除的65例經(jīng)胃鏡初診的食管胃結(jié)合部腺癌(Adenocarcinoma of esophagogastric junction,AEG)患者,所有研究對象均于術(shù)前行體表超聲(transabdominal ultrasoud,TUS)和CT檢查,術(shù)后均行病理檢查,觀察AEG的形態(tài)學(xué)表現(xiàn)并結(jié)合術(shù)后病理對AEG分型、TNM分期、腫瘤分化程度及腫塊大小方面進(jìn)行分析對比。結(jié)果65例AEG患者在癌胚抗原、糖類抗原19-9、腫瘤大小以及胸骨下角方面,各型間差異無統(tǒng)計學(xué)意義(均P0.05)。大體標(biāo)本BorrmannⅢ型31例,占47.7%,BorrmannⅡ型15例,占23.1%,組織學(xué)標(biāo)本低分化腺癌29例,占44.6%,中分化腺癌19例,占29.2%;參照Siewert分型,TUS和CT對AEG臨床分型診斷正確率分別為90.8%、92.3%,其中Ⅰ型分別為85.7%、92.9%,Ⅱ型分別為91.4%、88.6%,Ⅲ型分別為93.8%、100%,兩者診斷AEG分型存在一致性,差異有統(tǒng)計學(xué)意義(Kappa=0.852,P0.05);TUS及CT對AEG T分期的診斷準(zhǔn)確率分別為33.8%、63.1%,其中T1-3分別為29.4%、52.9%;T4分別為35.4%、66.7%,兩者在T分期診斷中差異有統(tǒng)計學(xué)意義(χ2=10.85,P=0.001),但在術(shù)前診斷為低分化的腺癌的AEG患者中,TUS與CT在T分期診斷中差異無統(tǒng)計學(xué)意義(χ2=0.26,P=0.61)。TUS及CT對AEG N分期的診斷準(zhǔn)確率分別為38.5%、50.8%,其中N0分別為87.5%、91.7%;N+分別為9.8%、26.8%,兩者在N分期診斷中差異無統(tǒng)計學(xué)意義(χ2=0.07,P=0.79)。TUS及CT對AEG M分期的診斷正確率均為98.5%。體表超聲測量腫瘤最長徑為4.00cm±1.84cm,術(shù)后病理測量腫瘤最長徑為4.41cm±2.52cm,兩者差異無統(tǒng)計學(xué)意義(t=-1.512,P0.05)。結(jié)論術(shù)前TUS能準(zhǔn)確判斷AEG的分型,有助于臨床制定手術(shù)路徑,對AEG的N、M分期有較高的臨床應(yīng)用價值;當(dāng)AEG患者術(shù)前胃鏡初診為低分化腺癌時,體表超聲和CT均可用于術(shù)前TNM分期;另外,體表超聲也是測量AEG腫瘤大小的可靠檢查手段,對于指導(dǎo)手術(shù)以及判斷預(yù)后有很大意義。
[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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